Clinical Profile and Management of Rheumatic Heart Disease in Children and Young Adults at a Tertiary Cardiac Center in Indonesia

Abstract

Introduction: Rheumatic heart disease (RHD) remains a major public health issue affecting children and young adults in developing countries. This study aimed to evaluate the clinical characteristics, management, and reactivation of RHD among children and young adults. Patients and Methods: This was a hospital-based retrospective study conducted at the National Cardiovascular Center Harapan Kita, Indonesia; we retrieved relevant data from patients diagnosed with RHD between 2012 and 2018. Results: Two hundred and seventy-nine patients were diagnosed with rheumatic heart disease, of whom 108 were children (mean age of 12.02 ± 3.36 years) and 171 were young adults (mean age was 24.9 ± 3.84). RHD was more common in female than in male young adults (1.5:1). Hospitalization due to RHD complications such as congestive heart failure was seen in 11.11% of cases in children, while pulmonary hypertension was present in 19.95% young adult cases. Reactivation of RHD occurred in 17.2% (48/279) cases, significantly in children (p < 0.001). Overall, the mitral valve (either isolated or combined) was the organ most affected in children (39.13%) and young adults (44.81%). Isolated mitral regurgitation was more common in children (13/21, 61.9%), while isolated mitral stenosis was more common in young adults (19/47, 40.42%). There was a high rate of rheumatic tricuspid valve disease in all populations (193/279, 69.17%) and reported involvement of pulmonary regurgitation (46/279, 16.48%). Multivalve lesions were more common than single lesions in both groups, with a combination of mitral and tricuspid regurgitation the predominant type in children (32/43, 74.41%) and mixed mitral lesion and tricuspid regurgitation in young adults (22/72, 30.56%). We observed a significant occurrence of quadrivalve lesions in children (p = 0.039). Valve repair was more common in children (49.07%) and replacement in young adults (32.16%), with low in-hospital mortality. Compliance with secondary prophylaxis was a significant challenge. Conclusion: Chronic RHD often presented with complications of the disease or reactivation of rheumatic fever (RF). Inadequate treatment of RF/RHD leads to extensive valvular damage and consequent disabilities. Efforts toward active early diagnosis and prompt treatment of RF/RHD and effective preventive measures are essential.

Clinical Cardiology in South East Asia: Indonesian Lessons from the Present towards Improvement

“…These data also suggested that women with RHD in LMICs largely consisted with childbearing age compared to upper-middle-income countries, which added more complications and burdens linked to this disease to LMICs [ 23 ]. In Indonesia, the baseline characteristics were in agreement with the results from the REMEDY study [ 24 ]. Recent study by Ambari et al showed that among RHD patients with mitral stenosis in Indonesia, majority (69.4%) were women, with a mean age of 39.3 – 41.2 years, 18% had hypertension, and 8.1% complicated with DM type 2 [ 25 ].…”

“…Along with it, training specialization on echocardiography for diagnostic of RHD amongst cardiologists, general physicians, and nurses could probably help reach the rural area [ 51 ]. Currently, Jones criteria for rheumatic fever diagnosis are less sufficient to diagnose recurrent rheumatic fever [ 24 ], thus adapted clinical pathway according to data from local studies needs to be developed. Aside from that, ensuring the availability of medicines, both for treatment and secondary prophylaxis are also priorities.…”

Clinical and Echocardiographic Profile of Rheumatic Heart Disease: A Cross-Sectional Study

“…The data suggest that recurrences of RF are higher in patients with RHD and each recurring disease episode further damages the heart [20]. The monitoring of medical therapy because RHD at this stage would warrant lifelong prophylaxis while in order to counter these recurrent attacks effective secondary prevention is required, which relies on accurate case detection for the appropriate use of prophylactic antibiotics and regular medical surveillance whereas the echocardiography plays an important role firstly, in early detection of RHD [21,22].…”

Challenges in Management of Pediatric Rheumatic Heart Disease in Indonesia: A Narrative Review

“…In East Java, 50 new cases of RHD were diagnosed in 2014-2015 [6]. A retrospective study from 2012 to 2018 in the national cardiac center Jakarta revealed a higher rate, with 108 cases in children of 279 total patients with RHD [7]. The higher rate of childhood RHD in East Java or Jakarta might be affected by the setting as tertiary cardiac centers.…”