{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T07:29:12Z","timestamp":1771054152257,"version":"3.50.1"},"reference-count":54,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,4,21]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Rheumatic heart disease disproportionately affects women of reproductive age, as it increases the risk of cardiovascular complications and death during pregnancy and childbirth. In sub\u2010Saharan Africa, clinical outcomes and adherence to guideline\u2010based therapies are not well characterized for this population.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              In a retrospective cohort study of the Uganda rheumatic heart disease registry between June 2009 and May 2018, we used multivariable regression and Cox proportional hazards models to compare comorbidities, mortality, anticoagulation use, and treatment cascade metrics among women versus men aged 15 to 44 with clinical rheumatic heart disease. We included 575 women and 252 men with a median age of 27 years. Twenty percent had New York Heart Association Class\n              <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content>\n              \u2010\n              <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>\n              heart failure. Among patients who had an indication for anticoagulation, women were less likely than men to receive a prescription of warfarin (66% versus 81%; adjusted odds ratio, 0.37; 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 0.14\u20130.96). Retention in care (defined as a clinic visit within the preceding year) was poor among both sexes in this age group (27% for men, 24% for women), but penicillin adherence rates were high among those retained (89% for men, 92% for women). Mortality was higher in men than women (26% versus 19% over a median follow\u2010up of 2.7 years; adjusted hazard ratio, 1.66; 95%\n              <jats:styled-content style=\"fixed-case\">CI,<\/jats:styled-content>\n              1.18\u20132.33).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Compared with men, women of reproductive age with rheumatic heart disease in Uganda have lower rates of appropriate anticoagulant prescription but also lower mortality rates. Retention in care is poor among both men and women in this age range, representing a key target for improvement.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.015562","type":"journal-article","created":{"date-parts":[[2020,4,16]],"date-time":"2020-04-16T09:04:09Z","timestamp":1587027849000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Outcomes and Care Quality Metrics for Women of Reproductive Age Living With Rheumatic Heart Disease in Uganda"],"prefix":"10.1161","volume":"9","author":[{"given":"Andrew Y.","family":"Chang","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine Stanford University Stanford CA"},{"name":"Department of Medicine Stanford University Stanford CA"},{"name":"Center for Innovation in Global Health Stanford University Stanford CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliet","family":"Nabbaale","sequence":"additional","affiliation":[{"name":"Uganda Heart Institute Mulago Hospital Kampala Uganda"},{"name":"University Hospitals Harrington Heart &amp; Vascular Institute Case Western Reserve University Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmy","family":"Okello","sequence":"additional","affiliation":[{"name":"Uganda Heart Institute Mulago Hospital Kampala Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isaac","family":"Ssinabulya","sequence":"additional","affiliation":[{"name":"Uganda Heart Institute Mulago Hospital Kampala Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Barry","sequence":"additional","affiliation":[{"name":"Department of Medicine Stanford University Stanford CA"},{"name":"Center for Innovation in Global Health Stanford University Stanford CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea Z.","family":"Beaton","sequence":"additional","affiliation":[{"name":"The Heart Institute Cincinnati Children\u2019s Hospital Medical Center &amp; The University of Cincinnati School of Medicine Cincinnati OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allison R.","family":"Webel","sequence":"additional","affiliation":[{"name":"Frances Payne Bolton School of Nursing Case Western Reserve University Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9468-0179","authenticated-orcid":false,"given":"Chris T.","family":"Longenecker","sequence":"additional","affiliation":[{"name":"University Hospitals Harrington Heart &amp; Vascular Institute Case Western Reserve University Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)32154-2"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2010.01.364"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2011-301025"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2012.3310"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu449"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603693"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2013.03.006"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/clc.4960050403"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-7292(02)00029-2"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.06.063"},{"key":"e_1_3_2_12_2","article-title":"Penicillin for secondary prevention of rheumatic fever","volume":"002227","author":"Manyemba J","year":"2002","unstructured":"Manyemba J, Mayosi BM. 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