{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:54:59Z","timestamp":1787032499162,"version":"build-2736575974"},"posted":{"date-parts":[[2026,3,4]]},"group-title":"Cardiovascular Medicine","reference-count":27,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,3,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>This study of Malawian children with rheumatic heart disease (RHD) sought to detect demographic, clinical, and echocardiographic risk factors for mortality.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Pediatric patients with RHD were recruited from March to October, 2018 from clinic rosters and inpatient consults in Lilongwe and Blantyre, Malawi. An echocardiogram was performed upon study enrollment. Cox regression analyses were performed to assess for factors associated with mortality over nearly 2 years of follow-up.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 118 patients, nearly two-thirds were female (64.4%) and median age was 12 (IQR 10-14). Just under half (47.0%) lived &gt;40km from a tertiary care center. There was a high prevalence of severe mitral regurgitation (65.3%), and pericardial effusion was present in 18.6%. Nearly a quarter (23.7%) died during follow-up. In univariable Cox regression, living &gt;40km from tertiary care, living in a remote area, moderate or severe malnutrition, taking a beta blocker, severe mitral stenosis, any severe valve disease, severe left atrial enlargement, and presence of a pericardial effusion were statistically significant risk factors for mortality (p&lt;0.05). In the adjusted model, living &gt;40km from tertiary care (HR 2.66, CI 1.06-6.07, p=0.037), malnutrition (mild HR 3.92, CI 1.03-14.91, p=0.045); moderate HR 7.41, CI 1.92-28.54, p=0.004; severe HR 4.91, CI 1.44-16.71, p=0.011), beta blocker use (HR 4.62, CI 1.63-13.10, p=0.004), and presence of a pericardial effusion (HR 6.96, CI 3.00-16.13, p&lt;0.001) remained independent risk factors for mortality.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This study of Malawian children emphasizes the dire prognosis of RHD in under-resourced settings and provides potential area of focus for targeted intervention.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.02.28.26346960","type":"posted-content","created":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T03:40:13Z","timestamp":1772682013000},"source":"Crossref","is-referenced-by-count":1,"title":["Distance from tertiary care, pericardial effusion, and nutritional status predict all-cause mortality among Malawian children with rheumatic heart disease"],"prefix":"10.64898","author":[{"given":"Jillian","family":"Olsen","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics, Texas Children\u2019s Hospital and Baylor College of Medicine, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yamikani","family":"Chimalizeni","sequence":"additional","affiliation":[{"name":"Kamuzu University of Health Sciences, Department of Paediatrics and Child Health, Blantyre, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Carapetis","sequence":"additional","affiliation":[{"name":"Telethon Kids Institute, University of Western Australia and Perth Children\u2019s Hospital, Perth, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Msandeni","family":"Chiume","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah Murphy","family":"Gunter","sequence":"additional","affiliation":[{"name":"The William T. Shearer Center for Human Immunobiology and the National School of Tropical Medicine, Division of Tropical Medicine, Department of Pediatrics, Texas Children\u2019s Hospital and Baylor College of Medicine, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina","family":"Hosseinipour","sequence":"additional","affiliation":[{"name":"University of North Carolina Project, University of North Carolina, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kazembe","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Clinical Center of Excellence, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subhrajit","family":"Lahiri","sequence":"additional","affiliation":[{"name":"OSF Congenital Heart Center, Department of Pediatrics, University of Illinois, Peoria, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Treasure","family":"Mkaliainga","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristy O.","family":"Murray","sequence":"additional","affiliation":[{"name":"The William T. Shearer Center for Human Immunobiology and the National School of Tropical Medicine, Division of Tropical Medicine, Department of Pediatrics, Texas Children\u2019s Hospital and Baylor College of Medicine, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Penny","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics, Texas Children\u2019s Hospital and Baylor College of Medicine, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tayamika","family":"Tambala","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anirudh","family":"Vinnakota","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Baylor College of Medicine, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5545-5729","authenticated-orcid":false,"given":"Amy","family":"Sanyahumbi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics, Texas Children\u2019s Hospital and Baylor College of Medicine, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"issue":"2","key":"2026030702100641000_2026.02.28.26346960v1.1","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1097\/HCO.0000000000000269","article-title":"Update on rheumatic heart disease","volume":"31","year":"2016","journal-title":"Curr Opin Cardiol"},{"key":"2026030702100641000_2026.02.28.26346960v1.2","unstructured":"World Health Organization Seventy-First World Health Assembly, Rheumatic fever and rheumatic heart disease, A71\/ 25 (2018)."},{"key":"2026030702100641000_2026.02.28.26346960v1.3","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2013.34"},{"key":"2026030702100641000_2026.02.28.26346960v1.4","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.ijcard.2017.04.004","article-title":"Clinical outcomes for young people with screening-detected and clinically-diagnoses rheumatic heart disease in Fiji","volume":"240","year":"2017","journal-title":"International Journal of Cardiology"},{"key":"2026030702100641000_2026.02.28.26346960v1.5","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2021-320356"},{"key":"2026030702100641000_2026.02.28.26346960v1.6","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.024769"},{"issue":"2","key":"2026030702100641000_2026.02.28.26346960v1.7","first-page":"32","article-title":"Trends in deaths from rheumatic heart disease in the eastern Mediterranean region: burden and challenges","volume":"5","year":"2018","journal-title":"J. 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