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OP-076 Outcomes and prognostic factors of rheumatic heart disease in Indonesian children
  1. Diadra Annisa,
  2. Najib Advani,
  3. Dina Muktiarti
  1. Universitas Indonesia


Aim Rheumatic heart disease (RHD) is a major contributor of preventable cardiovascular disease in children. Indonesia is one of the most endemic countries with RHD. However, data on clinical outcomes and prognostic factors are still lacking. This study aimed to evaluate the five-year survival rate, proportion of valve improvement, and prognostic factors of both outcomes.

Material and Method We conducted a retrospective cohort study in a tertiary hospital in Jakarta, Indonesia which included patients aged below 18 years at diagnosis before December 2018. Subjects were followed for 5 years up to December 2023. Factors analysed for both mortality and valve improvement were nutrition status, adherence to penicillin prophylaxis, New York Heart Association (NYHA) class, ejection fraction, valve severity, number of valve involved, and valve surgery.

Results One hundred patients with RHD were included with mean age of 11.29 (8.42–14.16) years. Mean duration of follow up was 47.96 (SD 20) months). The majority of valve abnormality was mitral regurgitation (32%). As many as 58% were diagnosed with severe valve disease. Five-year survival rate was 90%. Significant prognostic factors for mortality were ejection fraction <55% at diagnosis with HR 6.34 (95%CI 1.72–23.46; p=0.006) and NYHA class III-IV at diagnosis with HR 5.33 (95%CI 1,05–27.11; p=0.04. The proportion of subjects with valve improvement after 5 years were 60%. Multivariate analysis revealed that valve surgery was the only significant factor for valve improvement with RR 1.40 (95%CI 1.05–1.88; p=0.02). Subgroup analysis in subjects who did not undergo surgery showed that NYHA class I-II significantly affected valve improvement with RR 5,85 (95%CI 1,14–30,05; p = 0,03).

Conclusions The five-year survival rate of children with RHD was 90%. Mortality predictors were ejection fraction <55% and NYHA class III-IV at diagnosis. Sixty percent of patients had valve improvement with valve surgery as a predictor.

  • rheumatic heart disease
  • survival
  • valve improvement
  • pediatric
  • heart failure

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