Characteristics and Problems of Rheumatic Heart Disease in Indonesia: The Ina-RHD Multicenter Study

Abstract

BACKGROUND: Rheumatic heart disease (RHD) presents a significant public health challenge. Unfortunately, there is a lack of national data regarding the incidence and prevalence of RHD in Indonesia. OBJECTIVES: The purpose of this study was to evaluate the characteristics, burdens, and problems of RHD in Indonesia. METHODS: We collected medical reports of RHD patients over 18 years of age from 21 hospitals. Secondary data about clinical and echocardiography was collected to describe the characteristics, disease conditions, and complications of the disease. RESULTS: We recruited 3,431 patients, average age was 44 years, and 64.4% (2,209 of 3,431) were women. Dyspnea was found in 85.7% (2,939 of 3,431), and 25% (862 of 3,431) of patients with NYHA functional class III to IV. Isolated mitral stenosis was the most prevalent valve lesion in 1,357 of 3,431 patients (39.6%). A total of 62.5 % (2,146 of 3,431) of patients had atrial fibrillation (AF), with the highest prevalence being in MV lesions. Vitamin K antagonist was prescribed in 2,411 of 3,431 (70.3%) of patients. A history of stroke was reported in 227 of 3,431 (6.6%) of patients and most frequently happened in isolated mitral stenosis patients 128 of 1,357 (9.4%). Finally, secondary prophylaxis was only administered in 1,279 of 3,431 (37.3%) of patients, and only 23.2% (796 of 3,431) had it regularly. CONCLUSIONS: Our patients were predominantly women and had isolated mitral stenosis. Many patients came at a later stage of the disease, with older average age, a high prevalence of AF, pulmonary hypertension, and right heart involvement. The challenges were suboptimal use of anticoagulation despite the high prevalence of AF and underused secondary prophylaxis.

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