title: Characteristics and outcomes of Indian children enrolled in a rheumatic heart disease registry.
abstract: BACKGROUND
  Rheumatic heart disease (RHD) causes significant morbidity among children of low and middle-income countries. We aimed to assess characteristics and outcomes of Indian children enrolled in a tertiary care hospital RHD registry.
  
  
  METHODS
  Pediatric patients (≤18years) were prospectively enrolled over three years. We evaluated their clinical and echocardiographic characteristics, valvular interventions, adherence to penicillin prophylaxis, and mortality.
  
  
  RESULTS
  451 patients were enrolled in the registry (mean age 12.2±3.2years, 34% females). Females had greater burden of exercise intolerance than males (26.8% NYHA classes III-IV versus [vs] 13.8%, p<0.01). Among 388 patients with no prior interventions, mitral regurgitation was the most common lesion (48.7%). 279 patients (71.9%) had severe valvular disease and this proportion was higher in females than males (80.9% vs. 67.6%, p<0.01). 248 patients received AHA/ACC class I recommendation for valvular interventions and 53 (21.4%) underwent an intervention during 11month (median) follow-up. Age (adjusted odds ratio [aOR] 1.18, 95% confidence interval [CI] 1.03-1.36), NYHA classes III-IV (aOR 4.96, 95% CI 2.51-9.60), mitral stenosis (aOR 37.01, 95% CI 6.96-196.74), and mixed mitral valve disease (aOR 2.79, 95% CI 1.03-7.56) were predictive of undergoing an intervention. Mean adherence to penicillin prophylaxis among 274 patients with clinic follow-up was 93.6%. 14 patients (3.1%) died during follow-up.
  
  
  CONCLUSIONS
  Females had greater disease severity in an Indian pediatric RHD registry. Adherence to penicillin prophylaxis in the cohort was good. After 11months follow-up, one in five patients underwent a guideline-recommended intervention. Mortality was high during this short follow-up period.
authors: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors: Anurag
authors: A
authors: Mehta
authors: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: anitasaxena@hotmail.com.
authors: Anita
authors: A
authors: Saxena
authors: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
authors: Rajnish
authors: R
authors: Juneja
authors: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
authors: Sivasubramanian
authors: S
authors: Ramakrishnan
authors: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
authors: Saurabh
authors: S
authors: Gupta
authors: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
authors: Shyam Sundar
authors: SS
authors: Kothari
mesh_terms: D019072:Antibiotic Prophylaxis / Q000379:methods*; D002648:Child; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D012042:Registries; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D015996:Survival Rate / Q000639:trends
keywords: Low and middle-income countries; Pediatrics; Penicillin prophylaxis; Rheumatic heart disease