{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T11:56:50Z","timestamp":1793707010041,"version":"4.6.1"},"reference-count":18,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2024,7,9]]},"abstract":"<jats:sec id=\"ab-joi240058-4\"><jats:title>Importance<\/jats:title><jats:p>Rheumatic heart disease (RHD) remains a public health issue in low- and middle-income countries (LMICs). However, there are few large studies enrolling individuals from multiple endemic countries.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi240058-5\"><jats:title>Objective<\/jats:title><jats:p>To assess the risk and predictors of major patient-important clinical outcomes in patients with clinical RHD.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi240058-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>Multicenter, hospital-based, prospective observational study including 138 sites in 24 RHD-endemic LMICs.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi240058-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was all-cause mortality. Secondary outcomes were cause-specific mortality, heart failure (HF) hospitalization, stroke, recurrent rheumatic fever, and infective endocarditis. This study analyzed event rates by World Bank country income groups and determined the predictors of mortality using multivariable Cox models.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi240058-8\"><jats:title>Results<\/jats:title><jats:p>Between August 2016 and May 2022, a total of 13\u202f696 patients were enrolled. The mean age was 43.2 years and 72% were women. Data on vital status were available for 12\u202f967 participants (94.7%) at the end of follow-up. Over a median duration of 3.2 years (41\u202f478 patient-years), 1943 patients died (15% overall; 4.7% per patient-year). Most deaths were due to vascular causes (1312 [67.5%]), mainly HF or sudden cardiac death. The number of patients undergoing valve surgery (604 [4.4%]) and HF hospitalization (2% per year) was low. Strokes were infrequent (0.6% per year) and recurrent rheumatic fever was rare. Markers of severe valve disease, such as congestive HF (HR, 1.58 [95% CI, 1.50-1.87]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001), pulmonary hypertension (HR, 1.52 [95% CI, 1.37-1.69]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001), and atrial fibrillation (HR, 1.30 [95% CI, 1.15-1.46]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) were associated with increased mortality. Treatment with surgery (HR, 0.23 [95% CI, 0.12-0.44]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) or valvuloplasty (HR, 0.24 [95% CI, 0.06-0.95]; <jats:italic>P<\/jats:italic>\u2009=\u2009.042) were associated with lower mortality. Higher country income level was associated with lower mortality after adjustment for patient-level factors.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi240058-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>Mortality in RHD is high and is correlated with the severity of valve disease. Valve surgery and valvuloplasty were associated with substantially lower mortality. Study findings suggest a greater need to improve access to surgical and interventional care, in addition to the current approaches focused on antibiotic prophylaxis and anticoagulation.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jama.2024.8258","type":"journal-article","created":{"date-parts":[[2024,6,5]],"date-time":"2024-06-05T15:47:02Z","timestamp":1717602422000},"page":"133","source":"Crossref","is-referenced-by-count":54,"title":["Mortality and Morbidity in Adults With Rheumatic Heart Disease"],"prefix":"10.1001","volume":"332","author":[{"given":"Ganesan","family":"Karthikeyan","sequence":"first","affiliation":[{"name":"Department of Cardiology, All India Institute of Medical Sciences, New Delhi"},{"name":"Translational Health Science and Technology Institute, Faridabad, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mpiko","family":"Ntsekhe","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shofiqul","family":"Islam","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumathy","family":"Rangarajan","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvaro","family":"Avezum","sequence":"additional","affiliation":[{"name":"International Research Center, Hospital Alem\u00e3o Oswaldo Cruz, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Benz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tantchou Tchoumi Jacques","family":"Cabral","sequence":"additional","affiliation":[{"name":"St. Elizabeth Catholic General Hospital, Shisong Cardiac Centre, Kumbo, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ma","family":"Changsheng","sequence":"additional","affiliation":[{"name":"Beijing Anzhen Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philly","family":"Chillo","sequence":"additional","affiliation":[{"name":"Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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