Survival of Rheumatic Heart Disease in Indonesian Children
Penulis/Author
dr. Nadya Arafuri, Sp.A(K) (1); Prof. dr. Indah Kartika Murni, M.Kes., Sp.A(K)., Ph.D. (2); Prof. dr. Madarina Julia, Sp.A(K), MPH., Ph.D. (3); dr. Sasmito Nugroho, Sp.A(K). (4); dr. Noormanto,Sp.A(K) (5)
Tanggal/Date
2022
Kata Kunci/Keyword
Abstrak/Abstract
Background: Rheumatic heart disease (RHD) remains a preventable cause of
cardiovascular deaths in children in low- and middle-income countries. However, longterm
outcome data of children with RHD is still lacking in Indonesia.
Objective: To investigate the long-term outcomes of RHD, particularly the survival
rates and the predictors.
Methods: A retrospective cohort study was done in children aged less than 18 years
old admitted with RHD at a tertiary hospital (Dr. Sardjito Hospital, Indonesia) from
2011–2021. Survival time was estimated from the date of first diagnosis of RHD to the
survival endpoint (date of mortality or censoring). Kaplan-Meier curves, log-rank test
and Cox-regression analysis were used for survival analysis and the predictors.
Results: A total of 155 patients admitted with RHD during the study period. Of these,
14 (9.0%) deaths were reported as RHD related mortality with the mean age ±
standard deviation of 11.9 ± 2.9 years. Median follow up period was 16 months. The
survival rate at 1, 4, and 8 years were 93%, 86.1% and 60%, respectively. Survival was
lower in patients with severe valve lesions and NYHA functional class III-IV at the time
of diagnosis. Multivariate Cox-regression analysis showed the significant predictors
for mortality were poor adherence to penicillin and congestive heart failure, HR 12.7
(95%CI 1.4–113.5) and 18.6 (95%CI 1.8–185.0) respectively.
Conclusion: Approximately, only six in 10 children are able to survive at eight years after
diagnosis. Poor adherence to penicillin and congestive heart failure were predictors for
death. This study emphasizes the needs to improve the adherence of children with
RHD and early detection of subclinical carditis in children.
