BASELINE CLINICAL CHARACTERISTICS OF CONTEMPORARY ADULT CHRONIC RHEUMATIC HEART DISEASE IN IBADAN, NIGERIA

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O.S Ogah^1,3, A.T Adeyanju³, E.P Iyawe², K.F Okwunze² , M. Okeke² , A.C Ugah² , C.A Nwamadiegesi² , F.E Obiekwe², T.K. Afolabi², O.V. Adeyeye², C.H. Ezeh², A. Aje¹, A. Adebiyi^1,3

1. Department of Medicine, University College Hospital, Ibadan, Nigeria.
2. Alexander Brown Hall, College of Medicine, University of Ibadan, Nigeria.
3. Department of Medicine, University of Ibadan, Ibadan, Nigeria

Abstract

Introduction: Rheumatic heart disease (RHD) is a major public health issue, especially in developing countries. Globally, the largest increase in RHD incidence over 30 years was seen in sub-Saharan Africa, further contributing to the burden of cardiovascular disease in a region with high rates of hypertensive heart disease and cardiomyopathies. There are few reports describing the contemporary clinical profile of RHD in Nigeria.

Objective: The objective of the study is to describe the profile of RHD at the University College Hospital Ibadan. Methodology: This is an analysis of data collected on adult patients aged 18 years and above attending the cardiology service of the University College Hospital, Ibadan, Nigeria between September 1, 2016, and August 31, 2021. We collected information on the bio-data, clinical features, and echocardiographic diagnoses.

Results: During this period, 92 cases of RHD were diagnosed and 24 (26.1%) were male. The mean age of the study population was 49.67 ± 17.54 years, with ages ranging from 16 to 86 years. Most participants (45.7%) were within the age group of 30-49 years. Most (70.8%) of the participants presented in NYHA Class II heart failure. The most common presentation mode was dyspnea on
exertion and nocturnal cough (64.1%). Mitral regurgitation was the commonest lesion (65.4%)

Conclusion: Rheumatic heart disease is still a common cause of adult heart disease in Ibadan. There is a need for concerted efforts to tackle the burden of this disease by increasing screening among high-risk groups, improving access to healthcare, and increasing the uptake of secondary prophylaxis in those with a previous history of rheumatic fever. ‘

Keywords: Rheumatic fever, Rheumatic heart disease, Valvular heart disease, Clinical epidemiology.

Introduction

Rheumatic heart disease (RHD) is a chronic disease where severe damage occurs to heart valves due to a systemic immune process that follows pharyngeal infection by beta-hemolytic streptococcus.¹
Some of the commonly linked sequelae of rheumatic heart disease include heart failure, chronic atrial fibrillation, infective endocarditis and stroke.¹ In 2019, about 2.79 million new cases of RHD were diagnosed globally and more than 40 million individuals were affected.² The largest increase in RHD incidence over 30 years was seen in sub-Saharan Africa, further contributing to the burden of cardiovascular disease in a region with high rates of hypertensive heart disease and cardiomyopathies.³

Poor hygiene, overcrowding, and low socioeconomic status are widely recognized as factors responsible for the persisting burden of RHD. Health system challenges such as inadequate facilities for diagnosis, inadequate treatment of pharyngitis, and reduced access to health care are also notable drivers of RHD.⁴ Although the social determinants of RHD have been characterized and the opportunities for prevention at both primary and secondary levels have been broadly discussed, RHD is still a significant cause of cardiovascular-related morbidity and mortality in developing countries.

The Global Rheumatic Heart Disease Registry (REMEDY) study which recruited more than 3000 patients with RHD reported that severe valvular disease was a strong predictor of mortality.⁵ Death rates were highest in developing countries where there is a scarcity of infrastructure and personnel to provide operative management for RHD. 4 In Nigeria, large-scale epidemiological studies to describe the burden and outcomes of rheumatic heart disease are sparse.^6-9 Multiple reports that have employed handheld echocardiography for screening in a healthy population have placed the prevalence of RHD between 3.1% and 9.8%.^9-11 This current study aims to describe the clinical characteristics, echocardiography findings, and outcomes of RHD seen at the University College Hospital, Ibadan, Nigeria.