Clinical Outcomes in 3343 Children and Adults With Rheumatic Heart Disease From 14 Low- and Middle-Income Countries: Two-Year Follow-Up of the Global Rheumatic Heart Disease Registry (the REMEDY Study)
Authors' conclusion
Patients with clinical rheumatic heart disease have high mortality and morbidity despite being young; those from low- and lower-middle-income countries had a poorer prognosis associated with advanced disease and low education.
Study context
- Population
- Children and adults with rheumatic heart disease in 14 low- and middle-income countries in Africa and Asia, enrolled 2010–20122,960 (88.5%) with known 24-month vital status
- Participants
- 3,343 children
- Outcome
- Mortality
- Follow-up
- 2 years
Methodological detailsmulticentre, 25 centres in 14 countries, Enrolment January 2010–November 2012; 2-year follow-up
- Multicentre
- 25 centres in 14 countries
- Enrolment January 2010–November 2012; 2-year follow-up
Main finding
As reported in the abstract
2-year case fatality
2-year case fatality rate (500 deaths)
16.9%
Mortality rate, first year
116.3/1000 patient-years
Mortality rate, second year
65.4/1000 patient-years
Median age at death
28.7 years
Observational data: associations, not effects.
Further findings
Independent predictors of death
| Comparison | HR (95% CI) | |
|---|---|---|
| Severe valve disease | 2.36 (1.80–3.11) | |
| Congestive HF | 2.16 (1.70–2.72) | |
| NYHA class III/IV | 1.67 (1.32–2.10) | |
| AF | 1.40 (1.10–1.78) | |
| Postprimary educationLower risk | 0.67 (0.54–0.85) | |
| Female sexLower risk | 0.65 (0.52–0.80) | |
| 0.20.5125Hazard ratio (log scale) |
| Outcome | HR (95% CI) | |
|---|---|---|
| Independent predictors of deathOlder age · per year increase | 1.02 (1.01–1.02) | |
| 0.512Hazard ratio (log scale) |
Morbidity over 2 years
- New congestive HF: 204 (6.9%)
- 38.42/1000 patient-years
- Stroke or TIA: 46 (1.6%)
- 8.45/1000 patient-years
- Recurrent acute rheumatic fever: 19 (0.6%)
- 3.49/1000 patient-years
- Infective endocarditis: 20 (0.7%)
- 3.65/1000 patient-years
Predictors of stroke/TIA or systemic embolism
- Previous stroke and older age were independent predictors
Mortality and valve surgery by country income
- Significantly higher age- and sex-adjusted mortality in low- and lower-middle-income vs upper-middle-income countries
- Valve surgery significantly more common in upper-middle-income than lower-middle- or low-income countries
Original publication
Clinical Outcomes in 3343 Children and Adults With Rheumatic Heart Disease From 14 Low- and Middle-Income Countries: Two-Year Follow-Up of the Global Rheumatic Heart Disease Registry (the REMEDY Study). Circulation. Published 4 October 2016. doi:10.
Summarised from the published abstract; every number is checked against it