Mortality and Morbidity in Adults With Rheumatic Heart Disease

作者：Ganesan Karthikeyan, Mpiko Ntsekhe, Shofiqul Islam, Sumathy Rangarajan, Álvaro Avezum, Alexander P. Benz, Tantchou Tchoumi Jacques Cabral, Changsheng Ma, Philly Chillo, Jesús Antonio González-Hermosillo, Bernard Gitura, Albertino Damasceno, Antonio Miguel L. Dans, Kairat Davletov, Alaa Elghamrawy, Ahmed ElSayed, Golden Tafadzwa Fana, Lillian Gondwe, Abraham Haileamlak, Azhar Mahmood Kayani, Peter Lwabi, Fathi Maklady, Onkabetse Julia Molefe‐Baikai, John Musuku, Okechukwu S. Ogah, María Paniagua, Emmanuel Rusingiza, Sanjib Kumar Sharma, Liesl Zühlke, Stuart J. Connolly, Salim Yusuf, INVICTUS Investigators, Monkgogi Goepamang, Julius Chacha Mwita, Auristela Isabel de Oliveira Ramos, Flávio Tarasoutchi, Milena Ribeiro Paixão, Marcelo Kirschbaum, Mariana Pezzute Lopes, Walkíria Samuel Ávila, Lília Nigro Maia, Marcelo Arruda Nakazone, Osana Costa, Maria Carmen Lemos, Lívia Costa de Oliveira, Jose Ferreira, José Francisco Kerr Saraiva, Midia Costa, Marina Marengo, Óscar Pereira Dutra, R.M. Guimarães, Humberto Vaz, Sergio Luiz Zimmerman, Weimar Souza, Weimar Queiroz, Adriana Ferreira de Souza, Maria H Vidotti, Jose Guilherme de Paula, Guilherme Fazolli, Mauro Esteves Hernandes, Jose Luiz Torati, Grazielly Pantano, Vanessa Pelarin, Flavia Arantes, Rodrigo Otávio Silveira Silva, Monique Cardoso, Gilmar Reis, César França, Túlio Fonseca e Silva Quadros, Flavio Giorgeto, Resende Elmiro, Silva Aguinaldo, César Minelli, Helen Mbuoh Anshoma, Jean Claude Ambassa, Liliane Mfevkev Kuate, Chris Nadege Nganou Gninotio, Ngo Youmba Ntep Gweth, Dzudie Anastase, D. Armel, Lionel Nana Keptukoua, Xin Du, Rong Hu, Jiahui Wu, Qiang Lv, Jing Cui, Qing Yu, Xudong Zhu, Wei Su, Wang Xiaomei, Shiyi Chen, Zhipeng Zhang, Qi Wang, Xin Zheng, Pengfei Liu, Cheng Rang, Sitao Xie, Chongwen Liu, Hailong Wang, Shudong Wang, Xuxia Zhang, Yinzhu Lian, Rui Wang, Mingfu Ma, Lan Dou Li, Yunlian Tan, Shouyan Zhang, Yunfei Gu, Jianfeng Chen, Hao Wang, Wu Pengyu, Luan Hong, Li Fu, Yongbin Xu, Xiao Jundan, Qingfu Li, Jinpo Sun, Cui Pei, Yanbo Niu, Yidi Wu, Honghua Yang, Xin Li, Chunyan Yang, Yanhui Shi, Chenglin Wu, Yan Qu, Mingzhong Zhao, Yong Cheng, Yiqiang Yuan, Qiong Huang, Xiuzhen Kong, Zhizhong Zhao, Qixia Heng, Xinjing Shi, Jing Zhang, Liu Ying, Gao Xin, YU Zhao-ping, Xi Vivien Wu, Guo Hunayu, Wang Xiaoying, Wei Zhang, Chichang Li, Zhongtao Wang, Hao Ding, Min Huang, Zhao Jinguo, Mingshui Yu, Cuiling Cao, Xiaoli Zhu, Xiaoqin Shi, Khalid Eltamawy, Osama Arafa, Mahmoud M. Youssif, Aly Kassem, Omar Saleh, Mohamed Hussam Al Shair, K Maghraby, Sameh Shaheen, Aly Ahmed Abouelhoda, Suliman Gharib, Ramadan Sadek, Yasser Abd el Hady, Elsah Asefa, Esayas Kebede Gudina, Ermias Habte Michael, Tadesse Dukessa Gemechu, Markos Duguma, Dejuma Yadeta, Berhanu Nega Alemu, Sintayehu Abebe, Tamrat Assefa, Desalew Mekonnen, Tigist Seleshi, Chala Fekadu, Abraha Hailu, Hagazi Tesfay, Berhane Yohannes Hailu, Hagos Kahsay, Kibreab Gidey, Teklay Gebrehawaria, Samuel Berhane, Teshome Abegaz Kamil, Tariku Egeno Shifa, Agete Tedewos Hirigo, Sisay Tesfaye Teshome, Seyife Kibru Yirdaw, Sandeep Singh, Nitish Naik, Siddharthan Deepti, Satyavir Yadav, Mohit Gupta, Girish MP, Ajay Sharma, Bhagya Narayan Pandit, Kumar Sudeep, Kapoor Aditya, Akshyaya Pradhan, Rishi Sethi, Gaurav Chaudhry, Yaday Virendra, Agarwal Smriti, Cholenahally Manjnath, Surya Prakash Narayanappa, C. M. Satvic, Lachikarthman Devegowda, Chandra Bhan Meena, Rajiv Bagarhatta, Shashi Mohan Sharma, Shekhar Kunal, Nutan Kumar, Alibek Mereke, Elijah Ogola, Wilson Sugut, Felix Barasa, Anthony Gikonyo, Stephen Odhiambo Omondi, Frank Watson Sinyiza, John Chipolombwe, Tamara Phiri, L Chavez, Ernesto Gutiérrez, Fransisco Mazon Flores, Edgar Rodriguez, Susano Lara Vaca, Juan Cabra, Sandra Saavedra, Manuel De los Rios, Gilmer Ruvalcaba, Esteban González López, Marco Alcocer, Ana Valéria Garcia Ramirez, Guillermo Ruiz Llamas, Paola Hernandez, A Montero Delgado, Ana Muholove, Angela Mateus, Ana Olga Mocumbi, Jyoti Agarwal, Roshan Chhetri, Prashant Mani Tripathi, Chandra Mani Adhikari, Urmila Shakya, Dipanker Prajapati, Reeju Manandhar, Rajesh Nepal, Sahadeb Prasad Dhungana, Rinku Ghimire, Sunil Babu Khanal, Samir Gautam, Mazhar I. Khan, Bishal KC, Shankar Laudari, Madhu Gupta, Shyam Raj Regmi, Bishnu Mani Dhital, Sudhir Regmi, K. P. Adhikari, Bhagawan Koirala, Ratnamani Gajurel, Hemant Shrestha, Sanjeev Thapa, Adeseye A. Akintunde, Taiwo Olunuga, Julius Adesina, Mahmoud U. Sani, Fidelia Bode-Thomas, Basil N. Okeahialam, Christopher Sabo Yilgwan, Ganiyu Amusa, Olukemi Ige, Solomon Danbauchi, Abiodun M. Adeoye, Ejiroghene Martha Umuerri, Amam Mbakwem, Casmir Amadi, Oyewole A. Kushimo, Muhammad Isa, Muhammad Abdullahi, Nelson Oguanobi, Zohaib Ullah Zahid, Jabar Ali, Mohammad Hafizullah, Feroz Memon, Shazia Kazi, Azhar Mahmood Kayani, Adeel ur Rehman, Abdul Wajid Khan Faisal, Aftab Ahmad Tarique, Abdul Sattar, Nadeem Hayat Mallick, Syed Asif Ali, Veronica Mayans, Luciano Pereira, José Alderete, Javier Galeano, Alberto Moran Salinas, Rocío del Pilar Falcón-Fleytas, Gustavo Escalada, Luz Cabral, Liz Fatecha, Gladys Bogado de Atobe, Carlos Enrique Gutierrez, C. Delmas, Claudine J. Coronel, Dahiana Ibarrola, Jose Donato A. Magno, Lauren Kay M Evangelista, Maria Teresa B. Abola, Leahdette Padua, Christie Mendoza-Reyes, Dennis Jose Sulit, Ma Jojo Mercado, Candy Angelica Sigua Cabaddu, Josefina Cruz, Jean Marie Vianney Ganza Gapira, Vincent Dusingizimana, Blanche Cupido, John Lawrenson, K Naicker, JACQUELINE RACHELLE CIROTA, Sliwa Hahnle Karen, Melvin Baby, Kandathil Thomas, MOEKETSI KHULILE, Samuel Alomatu, Pindile Mntla, Makgotsane J. Mphahlele, Andrew Ratsela, Pravin Manga, Doné Fourie, Allana Colleen Hemus, ELLEN MAKONLI MAKOTOKO, Altaf Alam, Richard Nethononda, Theema Nunkoo, Ruchika Meel, Elsadig Askar, Amna S. E. Elfaki, Lana Mohamed, Mohammed Elsayed, Alia Hagahmed, Sumia Mohammed, Hiba Algaali, Khalid M. E. Eltalib, Tagwa Saeed Ibrahim Badawe, Inas Hassab Elrasoul Kbashi, H. El-Hassan, Maysa Hamza, Molhim M.I. Ahmed, Rayan Elhussain, Rufaida Mutwali, Mohammad Qurashi Ahmed Medani, Nazar F.A. Mohamed, Hwida A.M. Elamin, Manal H.A. Elmadih, Maha Abdelgader, Magdi Yousif, Tagwa Elfatih, Osama Hafiz Elshazali, Elaf Esmaeel Esawi, Awad A.M.A. Mohammed, Omer I.A. Hassan, Khansa Mahgoub, Maarib Maki, Omaima A.M.Abozaid, Naizihijwa Majani, Emmanuel Stephano Mtullo, Clement Kabakama, Issakwisa Habakkuk Mwakyula, John Meda, Emmy Okello, Pamela Chansa, Ngosa Mumba, Fastone Goma, Caroline Musemwa, Rudo Gwini · 发表于：JAMA · 年份：2024 · DOI：10.1001/jama.2024.8258 · 被引用次数：46 · 研究领域：Streptococcal Infections and Treatments、Infective Endocarditis Diagnosis and Management、Rheumatoid Arthritis Research and Therapies

Importance: Rheumatic 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. Objective: To assess the risk and predictors of major patient-important clinical outcomes in patients with clinical RHD. Design, Setting, and Participants: Multicenter, hospital-based, prospective observational study including 138 sites in 24 RHD-endemic LMICs. Main Outcomes and Measures: The 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. Results: Between 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 co...