Outcome in children with newly diagnosed rheumatic heart disease in Indonesia

ABSTRACT

Background

Rheumatic heart disease (RHD) is associated with high morbidity and mortality, especially in those with severe RHD or progression of valvular disease (VD). Evaluation of the factors that predict valvular progression is important in order to improve clinical outcome.

Aim

To evaluate outcome and clinical predictors of valvular progression in children with newly diagnosed RHD.

Methods

A retrospective cohort study was conducted in children with newly diagnosed RHD at Dr Sardjito Hospital, Yogyakarta, Indonesia during 2013–2020. Clinical and echocardiography data at the time of diagnosis were collected and patients were followed up for 1 year. Echocardiography evaluations were undertaken to determine the progression of VD. Independent predictors of valvular progression were identified by Cox regression analysis.

Results

A total of 77 patients were recruited, 36 (46.7%) of whom were male, and the median age (range) was 12.3 years (5.9–17.8). Thirty-three (42.8%) had progression of VD in the year after diagnosis. By multivariable analysis, an age at diagnosis of >10 years and high C-reactive protein (CRP) were independently associated with an increased risk of valvular progression with an adjusted hazard ratio (95% CI) of 3.23 (1.09–9.60) and 3.69 (1.45–9.67), respectively.

Conclusion

After only 1 year of follow-up, approximately four in 10 children with newly diagnosed RHD developed progression of VD. An increased risk of valvular progression was associated with being over 10 years of age and a high level of CRP.

KEYWORDS:

• Predictor
• valvular disease progression
• rheumatic heart disease
• Indonesia

Abbreviations

ARF, acute rheumatic fever; CRP, C-reactive protein; RHD, rheumatic heart disease; SD, standard deviation; VD, valvular disease; WHF, World Heart Federation; WHO, World Health Organization

Acknowledgments

We gratefully acknowledge Esta Rossa Sativa for collecting the data.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Indah K. Murni

Indah K Murni is a consultant paediatrician and paediatric cardiologist at DR Sardjito Hospital in Yogyakarta, Indonesia. Assoc Prof Murni is a lecturer in the Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada. She is a principal research fellow at the Centre for Child Health - Paediatric Research Office, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada.

Nadya Arafuri

Nadya Arafuri is a consultant paediatrician and paediatric cardiologist at the Dr Sardjito Hospital. She is lecturer and researcher in the Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada.

Andrew C. Steer

Andrew Steer is a consultant paediatrician and paediatric infectious diseases physician at the Royal Children’s Hospital. He is principal research fellow at the Centre for International Child Health in the Department of Paediatrics at the University of Melbourne, as well as Group Leader of the Group A Streptococcal Research Group at MCRI. Prof Steer holds a current NHMRC/NHF career development fellowship.

M. Taufik Wirawan

M Taufik Wirawan is undergoing his paediatric residency training program and master program in the Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/DR Sardjito Hospital.

Fransisca G. W. Remi

Fransisca GW Remi is paediatrician and she undertook her residency training program in the Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/DR Sardjito Hospital. She did her master program in the same institution.

Noormanto Noormanto

Noormanto is a consultant paediatrician and paediatric cardiologist at the DR Sardjito Hospital. He is lecturer in the Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada.

Sasmito Nugroho

Sasmito Nugroho is a consultant paediatrician and paediatric cardiologist at the DR Sardjito Hospital. He is lecturer in the Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada.