The severe presentation and poor outcomes of rheumatic heart disease in Namibia: Lessons from the REMEDY study
Background. This paper reports the baseline characteristics and outcomes of 266 Namibian patients in the Global Registry of Rheumatic Heart Disease. Objective. To describe clinical findings and outcomes in a cohort of children and adults with rheumatic heart disease in Namibia. Methods. Prospective...
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| Language: | English |
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South African Medical Association
2023-04-01
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| Series: | South African Medical Journal |
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| Online Access: | https://samajournals.co.za/index.php/samj/article/view/970 |
| _version_ | 1797368198862995456 |
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| author | T Auala L Zühlke L Sikwaya H du Toit G Karthikeyan K Teo S Yusuf M E Engels B M Mayosi C T Hugo-Hamman |
| author_facet | T Auala L Zühlke L Sikwaya H du Toit G Karthikeyan K Teo S Yusuf M E Engels B M Mayosi C T Hugo-Hamman |
| author_sort | T Auala |
| collection | DOAJ |
| description |
Background. This paper reports the baseline characteristics and outcomes of 266 Namibian patients in the Global Registry of Rheumatic Heart Disease.
Objective. To describe clinical findings and outcomes in a cohort of children and adults with rheumatic heart disease in Namibia.
Methods. Prospective study of all patients with rheumatic heart disease at Windhoek Central Hospital between January 2010 and November 2012.
Results. A total of 266 patients were enrolled; median age was 22 years, 72.6% were <30 years old and 60.5% female. The majority (62.8%) had moderate-severe disease; 48.9% were in congestive cardiac failure. Secondary antibiotic prophylaxis was used by 34.2%. Warfarin was used by 75.3% (n=64/85) with clinical indications. Forty-seven (17.6%) had previous valve interventions, of whom 40 (15.0%) had mechanical valve replacements. Over a 2-year follow-up period 19.1% of patients died. Severe valve involvement at enrolment was independently associated with mortality (24.6% v. 5.1% in those without severe disease; hazard ratio 4.9; 95% confidence interval 1.50 - 15.98). Sixty-five (29.8%) of the 218 without previous intervention had valvular intervention after enrolment.
Conclusions. In Namibia rheumatic heart disease affects young people who present with severe disease and have a high case fatality rate. Rates of secondary prevention were low. These findings have informed the National Programme for Prevention and Control of Rheumatic Heart Disease in Namibia.
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| first_indexed | 2024-03-08T17:29:12Z |
| format | Article |
| id | doaj.art-e17808c7fe0d4d0d9af1ff7100fad72c |
| institution | Directory Open Access Journal |
| issn | 0256-9574 2078-5135 |
| language | English |
| last_indexed | 2024-03-08T17:29:12Z |
| publishDate | 2023-04-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | South African Medical Journal |
| spelling | doaj.art-e17808c7fe0d4d0d9af1ff7100fad72c2024-01-02T17:26:50ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352023-04-01134b10.7196/SAMJ.2022.v113i3b.16831The severe presentation and poor outcomes of rheumatic heart disease in Namibia: Lessons from the REMEDY studyT Auala0L Zühlke1L Sikwaya2H du Toit3G Karthikeyan4K Teo5S Yusuf6M E Engels7B M Mayosi8C T Hugo-Hamman9Cardiac Unit, Windhoek Central Hospital, Ministry of Health and Social Services, Namibia; Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South AfricaDivision of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town, South Africa; Department of Cardiology, All India Institute of Medical Sciences, New Delhi, IndiaCardiac Unit, Windhoek Central Hospital, Ministry of Health and Social Services, NamibiaCardiac Unit, Windhoek Central Hospital, Ministry of Health and Social Services, NamibiaDepartment of Cardiology, All India Institute of Medical Sciences, New Delhi, IndiaPopulation Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, CanadaPopulation Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, CanadaDepartment of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South AfricaThe Deanery, Faculty of Health Sciences, University of Cape Town, Cape Town, South AfricaCardiac Unit, Windhoek Central Hospital, Ministry of Health and Social Services, Namibia; Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town, South Africa Background. This paper reports the baseline characteristics and outcomes of 266 Namibian patients in the Global Registry of Rheumatic Heart Disease. Objective. To describe clinical findings and outcomes in a cohort of children and adults with rheumatic heart disease in Namibia. Methods. Prospective study of all patients with rheumatic heart disease at Windhoek Central Hospital between January 2010 and November 2012. Results. A total of 266 patients were enrolled; median age was 22 years, 72.6% were <30 years old and 60.5% female. The majority (62.8%) had moderate-severe disease; 48.9% were in congestive cardiac failure. Secondary antibiotic prophylaxis was used by 34.2%. Warfarin was used by 75.3% (n=64/85) with clinical indications. Forty-seven (17.6%) had previous valve interventions, of whom 40 (15.0%) had mechanical valve replacements. Over a 2-year follow-up period 19.1% of patients died. Severe valve involvement at enrolment was independently associated with mortality (24.6% v. 5.1% in those without severe disease; hazard ratio 4.9; 95% confidence interval 1.50 - 15.98). Sixty-five (29.8%) of the 218 without previous intervention had valvular intervention after enrolment. Conclusions. In Namibia rheumatic heart disease affects young people who present with severe disease and have a high case fatality rate. Rates of secondary prevention were low. These findings have informed the National Programme for Prevention and Control of Rheumatic Heart Disease in Namibia. https://samajournals.co.za/index.php/samj/article/view/970Rheumatic Diseases |
| spellingShingle | T Auala L Zühlke L Sikwaya H du Toit G Karthikeyan K Teo S Yusuf M E Engels B M Mayosi C T Hugo-Hamman The severe presentation and poor outcomes of rheumatic heart disease in Namibia: Lessons from the REMEDY study South African Medical Journal Rheumatic Diseases |
| title | The severe presentation and poor outcomes of rheumatic heart disease in Namibia: Lessons from the REMEDY study |
| title_full | The severe presentation and poor outcomes of rheumatic heart disease in Namibia: Lessons from the REMEDY study |
| title_fullStr | The severe presentation and poor outcomes of rheumatic heart disease in Namibia: Lessons from the REMEDY study |
| title_full_unstemmed | The severe presentation and poor outcomes of rheumatic heart disease in Namibia: Lessons from the REMEDY study |
| title_short | The severe presentation and poor outcomes of rheumatic heart disease in Namibia: Lessons from the REMEDY study |
| title_sort | severe presentation and poor outcomes of rheumatic heart disease in namibia lessons from the remedy study |
| topic | Rheumatic Diseases |
| url | https://samajournals.co.za/index.php/samj/article/view/970 |
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