Outcomes and care quality metrics for people living with rheumatic heart disease and atrial fibrillation in Uganda.

Autor:	Opara CC; Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington., Lan RH; Department of Medicine, Stanford University School of Medicine, California., Rwebembera J; Department of RHD Research, Uganda Heart Institute, Kampala, Uganda., Okello E; Division of Cardiology, Uganda Heart Institute, Kampala, Uganda., Watkins DA; Department of Medicine, University of Washington, Seattle, Washington.; Department of Global Health, University of Washington, Seattle, Washington., Chang AY; Division of Cardiology, Department of Epidemiology and Population Health, Stanford University, California.; Center for Innovation in Global Health, Stanford University, Stanford, California.; Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California., Longenecker CT; Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington.; Department of Global Health, University of Washington, Seattle, Washington.
Jazyk:	angličtina
Zdroj:	Heart rhythm O2 [Heart Rhythm O2] 2024 Feb 15; Vol. 5 (4), pp. 201-208. Date of Electronic Publication: 2024 Feb 15 (Print Publication: 2024).
DOI:	10.1016/j.hroo.2024.02.002
Abstrakt:	Background: Atrial fibrillation (AF) is a common complication of rheumatic heart disease (RHD) and is challenging to treat in lower-resourced settings in which RHD remains endemic. Objective: We characterized demographics, treatment outcomes, and factors leading to care retention for participants with RHD and AF in Uganda. Methods: We conducted a retrospective analysis of the Uganda national RHD registry between June 2009 and May 2018. Participants with AF or atrial flutter were included. Demographics, survival, and care metrics were compared with participants without AF. Multivariable logistic regression was used to identify factors associated with retention in care among participants with AF. Results: A total of 1530 participants with RHD were analyzed and 293 (19%) had AF. The median age was 24 (interquartile range 14-38) years. Mortality was similar in both groups (adjusted hazard ratio 1.183, P = .77) over a median follow-up of 203 (interquartile range 98-275) days. A total of 79% of AF participants were prescribed anticoagulation, and 43% were aware of their target international normalized ratio. Retention in care was higher in participants with AF (18% vs 12%, P < .01). Factors associated with decreased retention in care include New York Heart Association functional class III/IV (adjusted odds ratio [OR] 0.48, 95% confidence interval [CI] 0.30-0.76) and distance to nearest health center (adjusted OR 0.94, 95% CI 0.90-0.99). Anticoagulation prescription was associated with enhanced care retention (adjusted OR 1.86, 95% CI 1.24-2.79). Conclusion: Participants with RHD and AF in Uganda do not experience higher mortality than those without AF. Anticoagulation prescription rates are high. Although retention in care is poor among RHD participants, those with concurrent AF are more likely to be retained. (© 2024 Heart Rhythm Society. Published by Elsevier Inc.)
Databáze:	MEDLINE
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