CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 3, April 2013
80
AFRICA
Cardiovascular complications in newly diagnosed
rheumatic heart disease patients at Mulago Hospital,
Uganda
EMMY OKELLO, ZHANG WANZHU, CHARLES MUSOKE, ALIKU TWALIB, BARBARA KAKANDE,
PETER LWABI, NYAKOOJO B WILSON, CHARLES K MONDO, R ODOI-ADOME, JUERGEN FREERS
Abstract
Background:
Complications of rheumatic heart disease are
associated with severe morbidity and mortality in developing
countries where the disease prevalence remains high. Due to
lack of screening services, many patients present late, with
severe valve disease. In Uganda, the disease and its complica-
tions are still not well studied.
Objective:
To profile and describe cardiovascular complica-
tions in newly diagnosed rheumatic heart disease patients
attending the Mulago National Referral Hospital in Uganda.
Methods:
This was a cross-sectional study where consecu-
tive, newly diagnosed rheumatic heart disease patients were
assessed and followed up for complications, such as heart
failure, pulmonary hypertension, atrial fibrillation, recur-
rence of acute rheumatic fever, and stroke.
Results:
A total of 309 (115 males and 196 females) definite
rheumatic heart disease patients aged 15–60 years were
enrolled in the study and analysed. Complications occurred
in 49% (152/309) of the newly diagnosed rheumatic heart
disease cases, with heart failure (46.9%) the most common
complication, followed by pulmonary arterial hypertension
(32.7%), atrial fibrillation (13.9%), recurrence of acute rheu-
matic fever (11.4%), infective endocarditis (4.5%) and stroke
(1.3%).Atrial fibrillation and acute rheumatic fever were the
most common complications associated with heart failure.
Conclusion:
In this study we found that about 50% of
newly diagnosed rheumatic heart disease patients in Uganda
presented with complications. Heart failure and pulmonary
arterial hypertension were the most commonly observed
complications.
Keywords:
rheumatic heart disease, complications, newly
diagnosed patients
Submitted 18/5/12, accepted 18/1/13
Cardiovasc J Afr
2013;
24
: 82–87
DOI: 10.5830/CVJA-2013-004
Worldwide, rheumatic heart disease (RHD) and its complications
result in about 233 000 deaths annually. The World Health
Organisation (WHO) estimates that approximately 16 million
people are currently affected by the disease.
1
The majority of
RHD cases occur in Africa where prevalence rates are as high as
one in 10 people in some communities.
1-3
Acute rheumatic fever is the result of a hyper-immune
response to Group A streptococcal infection in the susceptible
host. The resulting valvular damage, or RHD, is the only long-
term consequence of acute rheumatic fever. Lack of primary
prevention (treatment of group A streptococcal infections), and
lack of screening programmes to detect early RHD, results in late
disease presentation, with most patients only seeking medical
care due to symptoms related to complications of the disease.
Consequently, patients present with various long-term structural
and haemodynamic complications, such as heart failure, atrial
fibrillation and stroke.
4-6
The situation is worsened by low clinician knowledge in
the diagnosis and treatment of the disease and some of its
complications.
7
Late presentation denies patients an opportunity
for early intervention in the management the disease, including
early medical treatment and institution of benzathine penicillin
prophylaxis, which has been shown to prevent recurrence of
acute rheumatic fever.
8
Apart from a prevalence survey in primary schools, no
systemic study has documented the complications of RHD in
newly diagnosed patients in Uganda, making it difficult to design
guidelines for prevention, diagnosis and treatment.The awareness,
surveillance, advocacy and prevention (ASAP) programme was
developed to increase awareness and surveillance of RHD in
most affected countries.
9,10
The strategy aims at raising awareness
among the general public and healthcare workers about RHD,
and improving the quality of information regarding RHD. The
objective of the present study was to describe complications
as found in newly diagnosed RHD patients attending Mulago
National Referral Hospital in Uganda.
Methods
The study was approved by the Institutional Review Board (IRB)
of the School of Medicine, Makerere University College of
Health Sciences and the Uganda National Council for Science
and Technology (UNCST).
Department of Medicine, Division of Cardiology, College of
Health Sciences, Makerere University, Uganda
EMMY OKELLO, MB ChB, MMed,
ZHANG WANZHU, MB ChB
CHARLES MUSOKE, MB ChB
BARBARA KAKANDE, MB ChB, MMed
CHARLES K MONDO, MB ChB, MMed, PhD
JUERGEN FREERS, MB ChB, MMed
Uganda Heart Institute, Mulago National Referral Hospital,
Makerere University, Uganda
EMMY OKELLO, MB ChB, MMed
ALIKU TWALIB, MB ChB, MMed
BARBARA KAKANDE, MB ChB, MMed,
PETER LWABI, MB ChB, MMed,
NYAKOOJO B WILSON, MD, PhD
CHARLES K MONDO, MB ChB, MMed, PhD
School of Pharmacy, Makerere University, Uganda
R ODOI-ADOME, MB ChB, MSc, PhD
