Abstract

AUALA, T et al. The severe presentation and poor outcomes of rheumatic heart disease in Namibia: Lessons from the REMEDY study. SAMJ, S. Afr. med. j. [online]. 2023, vol.113, n.3b, pp.1104-1108. ISSN 2078-5135.  http://dx.doi.org/10.7196/SAMJ.2022.v113i3b.16831.

BACKGROUND: This paper reports the baseline characteristics and outcomes of 266 Namibian patients in the Global Registry of Rheumatic Heart Disease OBJECTIVE: To describe clinical findings and outcomes in a cohort of children and adults with rheumatic heart disease in Namibia METHODS: Prospective study of all patients with rheumatic heart disease at Windhoek Central Hospital between January 2010 and November 2012 RESULTS: A total of 266 patients were enrolled; median age was 22 years, 72.6% were <30 years old and 60.5% female. The majority (62.8%) had moderate-severe disease; 48.9% were in congestive cardiac failure. Secondary antibiotic prophylaxis was used by 34.2%. Warfarin was used by 75.3% («=64/85) with clinical indications. Forty-seven (17.6%) had previous valve interventions, of whom 40 (15.0%) had mechanical valve replacements. Over a 2-year follow-up period 19.1% of patients died. Severe valve involvement at enrolment was independently associated with mortality (24.6% v. 5.1% in those without severe disease; hazard ratio 4.9; 95% confidence interval 1.50 -15.98). Sixty-five (29.8%) of the 218 without previous intervention had valvular intervention after enrolment CONCLUSIONS: In Namibia rheumatic heart disease affects young people who present with severe disease and have a high case fatality rate. Rates of secondary prevention were low. These findings have informed the National Programme for Prevention and Control of Rheumatic Heart Disease in Namibia

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