Article
作者: Hirigo, Agete Tedewos ; Xiaomei, Wang ; Pantano, Grazielly ; Chansa, Pamela ; Chaudhry, Gaurav ; Satvic, Cholenahally ; Yuan, Yiqiang ; Sudeep, Kumar ; Thapa, Sanjeev ; Gondwe, Lillian ; Gikonyo, Anthony ; MPHAHLELE, MAKGOTSANE ; Wang, Qi ; Paniagua, Maria ; ElSayed, Mohammed ; Gwini, Rudo ; Gutierrez, Carlos ; Damasceno, Albertino ; Llamas, Guillermo ; Pengfei, Liu ; Guimaraes, Raphael ; Mwakyula, Issakwisa ; Mereke, Alibek ; Ratsela, Andrew ; MNTLA, PINDILE ; Kassem, Aly ; Sugut, Wilson ; Elghamrawy, Alaa ; Elmiro, Resende ; Gonzalez-Hermosillo, J. Antonio ; Alomatu, Samuel Yao ; Khan, Mazhar ; Elmadih, Manal H.A. ; Haileamlak, Abraham ; Zhang, Xuxia ; Umuerri, Ejiroghene ; Rehman, Adeel ; Ruvalcaba, Gilmer ; Shi, Xiaoqin ; Falcón, Rocío del Pilar ; Hamza, Maysa ; Mohamed, Nazar F.A. ; Yilgwan, Christopher ; Pengyu, Wu ; Du, Xin ; Tripathi, Prashant Mani ; Costa, Midia ; Wang, Rui ; AKINTUNDE, ADESEYE ; Kunal, Shekhar ; Wu, Yidi ; Cruz, Josefina ; Askar, Elsadig ; Maki, Maarib ; Hernandes, Mauro ; Esawi, Elaf Esmaeel ; Ogola, Elijah ; Maghraby, Khaled ; Majani, Naiz ; Chillo, Philly ; Yang, Honghua ; Ibarrola, Dahiana ; Hunayu, Guo ; Nethononda, Richard ; Tesfay, Hagazi ; Danbauchi, Solomon ; Zhang, Shouyan ; Kirschbaum, Marcelo ; Gupta, Mohit ; Sadek, Ramadan ; Khanal, Sunil Babu ; Zhongtao, Wang ; Hailu, Berhane Yohannes ; Xie, Sitao ; KC, Bishal ; Xiaoying, Wang ; Gidey, Kibreab ; Laudari, Shankar ; Prajapati, Dipanker ; Fatecha, Liz ; Cao, Cuiling ; Ambassa, Jean Claude ; MP, Girish ; Franca, Cesar ; Rodriguez Chavez, Laura Leticia ; Mwita, Julius ; Arantes, Flavia ; Yu, Zhaoping ; Ramirez, Ana ; Adhikari, Chandra Mani ; Shakya, Urmila ; Hassan, Omer I.A. ; Gitura, Bernard ; Singh, Sandeep ; Meel, Ruchika ; Yunfei, Gu ; Aguinaldo, Silva ; Hernandez, Paola ; Fekadu, Chala ; Mazon Flores, Fransisco ; IGE, Olukemi ; Sulit, Dennis Jose ; Pezzute Lopes, Mariana ; Liu, Chongwen ; Nakazone, Marcelo ; Mohamed, Lana ; Quadros, Tulio ; Elfaki, Amna ; Aditya, Kapoor ; Abdullahi, Muhammad Awwal ; Sharma, Shashi Mohan ; Devegowda, Lachikarthman ; Pelarin, Vanessa ; Olunuga, Taiwo ; Galeano, Javier ; Agarwal, Jyoti ; Elhassan, Huda Hamid ; Bode-Thomas, Fidelia ; Abola, Maria Teresa ; Mahgoub, Khansa ; Pereira, Luciano ; Reis, Gilmar ; Cabra, Juan ; Hong, Luan ; Kayani, Azhar Mahmood ; Abouelhoda, Aly Ahmed ; Zheng, Xin ; Shi, Xinjing ; Fu, Li ; Sun, Jinpo ; Hemus, Allana ; Okeahialam, Basil ; Thomas Baby, Mookenthottathil ; Barasa, Felix ; Adeoye, Abiodun Moshood ; Mbakwem, Amam ; Adhikari, Krishna ; Costa, Osana ; Algaali, Hiba ; Wang, Hailong ; Elfatih, Tagwa ; Lv, Qiang ; Ghimire, Rinku ; Manandhar, Reeju ; Mocumbi, Ana ; Zhao, Mingzhong ; Adesina, Julius ; Kumar, Nutan ; Queiroz, Weimar ; Li, Xin ; Teshome, Sisay Tesfaye ; Tarasoutchi, Flavio ; ElSayed, Ahmed ; Hussam Al Shair, Mohamed ; Shaheen, Sameh ; de Paula, Jose Guilherme ; Sharma, Sanjib Kumar ; Cui, Jing ; Ying, Liu ; Zuhlke, Liesl ; Yadeta, Dejuma ; Ahmed Medani, Mohammad Qurashi ; Omondi, Stephen ; Gharib, Suliman ; Coronel, Claudine ; Sattar, Abdul ; Zhang, Wei ; Mingfu, Ma ; KHULILE, MOEKETSI ; Kbashi, Inas Hassab Elrasoul ; Cabral, Luz ; Hayat Mallick, Nadeem ; Meda, John ; Kabakama, Clement ; Qingfu, Li ; Ali, Jabar ; Ahmed, Molhim M.I. ; Goepamang, Monkgogi ; Mercado, Ma Jojo ; Lopez, Esteban ; Connolly, Stuart ; Hailu, Abraha ; Dans, Antonio Miguel L. ; Assefa, Tamrat ; Giorgeto, Flavio ; Ali, Syed Asif ; Karthikeyan, Ganesan ; Mtullo, Emmanuel Stephano ; Wu, Xi ; Chhetri, Roshan ; Ntep Gweth, Ngo Youmba ; Souza, Adriana ; Jianfeng, Chen ; Cheng, Yong ; A.M.Abozaid, Omaima ; Rodriguez, Edgar ; Kahsay, Hagos ; Abebe, Sintayehu ; Musuku, John ; Phiri, Tamara ; Moran Salinas, Alberto ; Xudong, Zhu ; Qu, Yandong ; Gupta, Madhu ; Memon, Feroz ; Habte Michael, Ermias ; Oguanobi, Nelson ; Nepal, Rajesh ; Amadi, Casmir ; Yirdaw, Seyife Kibru ; Cardoso, Monique ; Wu, Jiahui ; Arafa, Osama ; Regmi, Shyam Raj ; Minelli, Cesar ; CIROTA, JACQUELINE RACHELLE ; Karen, Sliwa Hahnle ; Yang, Chunyan ; Silva, Rodrigo ; Alcocer, Marco ; Bogado de Atobe, Gladys ; Xin, Gao ; Virendra, Yaday ; Hagahmed, Alia ; Pradhan, Akshyaya ; Mutwali, Rufaida ; Gudina, Esayas Kebede ; Yousif, Magdi (Gameel) ; Paixao, Milena Ribeiro ; Anshoma, Helen Mbuoh ; Maklady, Fathi ; Sigua Cabaddu, Candy Angelica ; Alderete, Jose ; Gutierrez, Ernesto ; Tarique, Aftab Ahmad ; Zahid, Zohaib Ullah ; Zhang, Jing ; Hafizullah, Mohammad ; Hao, Wang ; Ntsekhe, Mpiko ; Fana, Golden Tafadzwa ; Marengo, Marina ; Islam, Shofiqul ; Elhussain, Rayan ; Naik, Nitish ; Benz, Alexander ; Musemwa, Caroline ; Isa, Muhammad ; Lawrenson, John ; Ramos, Auristela ; Siddharthan, Deepti ; Thomas, Kandathil Mathew ; Qing, Yu ; Shiyi, Chen ; Wu, Chenglin ; Yu, Mingshui ; Shrestha, Hemant ; Tan, Yunlian ; ALAM, A K M NOWSHAD ; De los Rios, Manuel ; Ferreira, Jose ; Dhital, Bishnu Mani ; Abdelgader, Maha ; Ogah, Okechukwu Samuel ; Jundan, Xiao ; Delmas, Cesar ; Avila, Walkiria ; Manjnath, Cholenahally ; Kazi, Shazia ; Zhu, Xiaoli ; Fourie, Doné ; Kong, Xiuzhen ; Zimmerman, Sergio Luiz ; Lemos, Maria ; Khan Faisal, Abdul Wajid ; Keptukoua, Lionel Nana ; Dutra, Oscar ; Zhao, Zhizhong ; Su, Wei ; Shifa, Tariku Egeno ; Hu, Rong ; Li, Lan Dou ; Meena, Chandra Bhan ; Manga, Pravin ; Yusuf, Salim ; Sharma, Ajay ; Mfevkev Kuate, Liliane ; Yongbin, Xu ; Changsheng, Ma ; Mekonnen, Desalew ; Padua, Leahdette ; Ding, Hao ; Abd El Hady, Yasser ; Sethi, Rishi ; Mohammed, Awad A.M.A. ; Sinyiza, Frank ; Cabral, Tantchou Tchoumi Jacques ; Rang, Cheng ; Elamin, Hwida A.M. ; Bagarhatta, Rajiv ; Torati, Jose Luiz ; Amusa, Ganiyu ; Mayans, Veronica ; Anastase, Dzudie ; Ganza Gapira, Jean Marie Vianney ; Gajurel, Ratnamani ; Kushimo, Oyewole ; Pandit, Bhagya Narayan ; Rangarajan, Sumathy ; Seleshi, Tigist ; Maia, Lilia ; Dhungana, Sahadeb Prasad ; Niu, Yanbo ; Mateus, Angela ; Yadav, Satyavir ; Lwabi, Peter ; Li, Chichang ; Gebrehawaria, Teklay ; Lara Vaca, Susano ; Alemu, Berhanu N ; Heng, Qixia ; Vidotti, Maria Helena ; Mendoza-Reyes, Christie ; Huang, Qiong ; Saleh, Omar ; Smriti, Agarwal ; Sani, Mahmoud ; Saraiva, Jose Francisco Kerr ; Dukessa Gemechu, Tadesse ; Rusingiza, Emmanuel ; NAICKER, KISHENDREE ; Magno, Jose Donato ; Dusingizimana, Vincent ; Fazolli, Guilherme ; Mumba, Ngosa ; Escalada, Gustavo ; Pei, Cui ; Avezum, Alvaro ; Lian, Yinzhu ; Molefe-Baikai, Onkabetse Julia ; Badawe, Tagwa S. I. ; Delgado, Angelica ; Vaz, Humberto ; Cupido, Blanche ; Nunkoo, Theema ; Goma, Fastone ; Eltalib, Khalid ; Eltamawy, Khalid ; Elshazali, Osama Hafiz ; Saavedra, Sandra ; Zhipeng, Zhang ; Kamil, Teshome Abegaz ; Souza, Weimar ; Asefa, Elsah ; Narayanappa, Surya Prakash ; Jinguo, Zhao ; Muholove, Ana ; Huang, Min ; Okello, Emmy ; Chipolombwe, John ; Nganou Gninotio, Chris Nadege ; Duguma, Markos ; Regmi, Sudhir ; Oliveira, Livia ; Mohammed, Sumia ; Wang, Shudong ; Youssif, Mahmoud ; Gautam, Samir ; Shi, Yanhui ; Berhane, Samuel ; Evangelista, Lauren Kay ; Makotoko, Ellen M ; Florent Armel, Djomou Ngongang ; Koirala, Bhagawan ; Davletov, Kairat
ImportanceRheumatic heart disease (RHD) remains a public health issue in low- and middle-income countries (LMICs). However, there are few large studies enrolling individuals from multiple endemic countries.ObjectiveTo assess the risk and predictors of major patient-important clinical outcomes in patients with clinical RHD.Design, Setting, and ParticipantsMulticenter, hospital-based, prospective observational study including 138 sites in 24 RHD-endemic LMICs.Main Outcomes and MeasuresThe primary outcome was all-cause mortality. Secondary outcomes were cause-specific mortality, heart failure (HF) hospitalization, stroke, recurrent rheumatic fever, and infective endocarditis. This study analyzed event rates by World Bank country income groups and determined the predictors of mortality using multivariable Cox models.ResultsBetween August 2016 and May 2022, a total of 13 696 patients were enrolled. The mean age was 43.2 years and 72% were women. Data on vital status were available for 12 967 participants (94.7%) at the end of follow-up. Over a median duration of 3.2 years (41 478 patient-years), 1943 patients died (15% overall; 4.7% per patient-year). Most deaths were due to vascular causes (1312 [67.5%]), mainly HF or sudden cardiac death. The number of patients undergoing valve surgery (604 [4.4%]) and HF hospitalization (2% per year) was low. Strokes were infrequent (0.6% per year) and recurrent rheumatic fever was rare. Markers of severe valve disease, such as congestive HF (HR, 1.58 [95% CI, 1.50-1.87]; P < .001), pulmonary hypertension (HR, 1.52 [95% CI, 1.37-1.69]; P < .001), and atrial fibrillation (HR, 1.30 [95% CI, 1.15-1.46]; P < .001) were associated with increased mortality. Treatment with surgery (HR, 0.23 [95% CI, 0.12-0.44]; P < .001) or valvuloplasty (HR, 0.24 [95% CI, 0.06-0.95]; P = .042) were associated with lower mortality. Higher country income level was associated with lower mortality after adjustment for patient-level factors.Conclusions and RelevanceMortality in RHD is high and is correlated with the severity of valve disease. Valve surgery and valvuloplasty were associated with substantially lower mortality. Study findings suggest a greater need to improve access to surgical and interventional care, in addition to the current approaches focused on antibiotic prophylaxis and anticoagulation.