Survival And Predictors Of Mortality Among Patients With Rheumatic Heart Disease Awaiting Valvular Surgery At Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia: A Retrospective Follow-Up Study, 2025.
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Date
2025-04
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Addis Ababa University
Abstract
Background: Rheumatic Heart Disease is a condition in which the heart valves are damaged through repeated episodes of rheumatic fever. Globally, around 40.5 million people were affected by the disease, and >306,000 individuals died annually. In most cases, the life-saving treatment for Rheumatic Heart Disease patients is valvular surgery. However, such life-saving cardiac surgeries are limited in resource-limited settings like Ethiopia.
Objective: This study aimed to assess survival and identify predictors of mortality among patients with Rheumatic Heart Disease awaiting valvular surgery at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia.
Methods: A hospital-based retrospective follow-up study was conducted at Tikur Anbesa Specialized Hospital among 436 patients with rheumatic heart disease who were registered for valvular surgery from January 1, 2018, to December 30, 2023. Data were collected through the review of medical records and telephone interviews. The Kaplan-Meier method, life table, and log-rank test were used to estimate survival and comparison. Predictor factors were identified using an adjusted Cox regression model with their corresponding 95% confidence interval; p-value <0.05.
Result: A total of 436 patients with Rheumatic Heart Disease were followed for 1,210.9 person-years, resulting in a mortality incidence rate of 108.89/1,000 person-years. The overall probability of survival at 2 years and 5 years was 80.9% and 59.0%, respectively. Independent predictors included right ventricular dysfunction (Adjusted hazard ratio: 3.03; 95% CI: 1.61–5.73), New York Heart Association class III/IV (Adjusted hazard ratio: 2.94; 95% CI: 1.58–5.46), multivalve lesion indicated for surgery (Adjusted Hazard Ratio: 1.54; CI: (1.05, 2.26), Infective Endocarditis (Adjusted hazard ratio: 2.39; 95% CI: 1.15–4.96), and patients aged <18 years had a significantly higher risk of mortality compared to those aged ≥18 with AHR=1.54, 95% CI, (1.01, 2.36).
CONCLUSION: This study underscores the high mortality rate among rheumatic heart disease patients awaiting valvular surgery, emphasizing the need for urgent intervention, risk stratification, and strict patient follow-up.
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Keywords
Rheumatic Heart Disease, Cardiac surgery, Ethiopia, Tikur Anbesa.