Progressive deterioration in clinical outcome in RHD: influence of therapeutic interventions

Abstract

Rheumatic Heart Disease (RHD) continues to be a major cause of morbidity and mortality in many low- and middle-income countries as well as in the form of outbreaks in developed countries. However, the long-term outcome and its determinants remain understudied. 

A total of 2595 consecutive patients with RHD were enrolled in a hospital-based registry prospectively from March 2009 to April 2023. Their baseline characteristics, the pattern, and severity of valvular involvement were defined. Patients were followed-up at 6-monthly intervals (6-170 months (53±31.6) (complete in 92.6% of patients).

Patients judged to have moderate or severe disease had intervention (group 1). Group 2 had no intervention. Outcome was defined as: 1) survival, as well as 2) combined endpoint of cardiovascular (CV) event: atrial arrhythmia, thrombo-embolic event and/or cerebrovascular accident. 

A total of 1273 (49%) patients underwent surgical (n=978, 77%) or percutaneous (n=295, 23%) cardiac interventions, of which 35 (3%) were emergency.

During the study period, 347 patients (13%) died. CV events were experienced in 385 patients. Both groups continued to show progressive deterioration in CV outcomes during follow-up. Undergoing intervention was associated with lower risk of both mortality and CV event (Figure 1).

All patients with RHD continue to have deterioration in outcome, however, intervention slows down the deterioration. Further efforts to determine the exact causes involved and improve prognosis are warranted.