Rheumatic heart disease pattern and treatment experience at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
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Date
2020-12
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Addis Abeba University
Abstract
Background: Despite high prevalence of RHD in Ethiopia, studies on characteristics,
complications, and treatment practices are limited in number. It is therefore important; to describe
echocardiographic and clinical characteristics and identify the gaps we have in this setting and
our level of care.
Methods: Using a cross-sectional study design 256 patients were recruited over a span of two
month between June 01, 2020-july 30, 2020. Using Convenience sampling method, all RHD
Patients who visited the cardiac clinic during the study period and who fulfilled the inclusion
criteria were included in the study. Data was collected using checklist which included back
ground information, clinical characteristics, electrocardiography (ECG) findings,
echocardiography finding and both medical and surgical management. Data was first checked
manually for completeness and then analyzed using SPSS version 26.0.
Results: Among 256 RHD patients, the median age was 30 years. Females (75%) and patients
who had urban area (75.8%) were affected predominantly. The majority had combined valvular
lesion(75.5%) and severe/very sever valvular lesion (78.1). MR was the most common valvular
lesion (76.4%) followed by MS (73%), AR (59.2%), TR( 51.9%), AS(15.5%). Mitral valve was
the commonest valve affected (94.8%) followed by aortic valve (60.9%). The valve lesion was
complicated by high prevalence of pulmonary hypertension (69.5%), chamber dilatation,
symptoms of advanced heart failure (53.6%) and atrial fibrillation (32.4%) and stroke (5.5%).
The presence of advanced heart failure was found significantly associated with MS(COR, 2.150;
95% CI, 1.168 to 3.956; P=0.014), AR(COR,1.90; 95% CI,1.112 to 3.250; P=0.019), TR(COR,
3.258; 95% CI, 1.896 to 5.598; P=0.00001), RVSD(COR, 4.456; 95% CI,2.111 to 9.404;
P=0.00008), and LA enlargement(COR, 1.069; 95% CI, 1.041 to 1.098; P=0.000). Average
annual adherence to secondary antibiotic prophylaxis was 73.58% and only 62.1% of patients
had good adherence (taking ≥80% of their prescribed monthly BP prophylaxis dose). Even
though 94.8% patients identified to be at high risk for stroke and peripheral embolism were
receiving OAC, only 57.6% of patients had therapeutic level INR. Although 83.2% of patients
required percutaneous/surgical valve intervention done only for 17.8% of patients with
significant urban bias (COR, 7.200; 95% CI, 1.670 to 31.039; P=0.008).
Conclusion: RHD patients were young and middle-aged, predominantly females and had high
rate of cardiovascular complication. There is suboptimal use of secondary antibiotics
prophylaxis, INR control and limited and biased access to percutaneous/surgical intervention.
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Keywords
Rheumatic heart disease, Congestive heart failure, Valvuloplasty, Valve surgery