Division of Cardiovascular Medicine Stanford University Stanford CA.
Department of Medicine Stanford University Stanford CA.
J Am Heart Assoc. 2020 Apr 21;9(8):e015562. doi: 10.1161/JAHA.119.015562. Epub 2020 Apr 16.
Background Rheumatic heart disease disproportionately affects women of reproductive age, as it increases the risk of cardiovascular complications and death during pregnancy and childbirth. In sub-Saharan Africa, clinical outcomes and adherence to guideline-based therapies are not well characterized for this population. Methods and Results In a retrospective cohort study of the Uganda rheumatic heart disease registry between June 2009 and May 2018, we used multivariable regression and Cox proportional hazards models to compare comorbidities, mortality, anticoagulation use, and treatment cascade metrics among women versus men aged 15 to 44 with clinical rheumatic heart disease. We included 575 women and 252 men with a median age of 27 years. Twenty percent had New York Heart Association Class III-IV heart failure. Among patients who had an indication for anticoagulation, women were less likely than men to receive a prescription of warfarin (66% versus 81%; adjusted odds ratio, 0.37; 95% CI, 0.14-0.96). Retention in care (defined as a clinic visit within the preceding year) was poor among both sexes in this age group (27% for men, 24% for women), but penicillin adherence rates were high among those retained (89% for men, 92% for women). Mortality was higher in men than women (26% versus 19% over a median follow-up of 2.7 years; adjusted hazard ratio, 1.66; 95% CI, 1.18-2.33). Conclusions Compared with men, women of reproductive age with rheumatic heart disease in Uganda have lower rates of appropriate anticoagulant prescription but also lower mortality rates. Retention in care is poor among both men and women in this age range, representing a key target for improvement.
风湿性心脏病在育龄妇女中发病率不成比例，因为它会增加妊娠和分娩期间心血管并发症和死亡的风险。在撒哈拉以南非洲，该人群的临床结局和基于指南的治疗方法的依从性尚未得到很好的描述。
在 2009 年 6 月至 2018 年 5 月期间，乌干达风湿性心脏病登记处的一项回顾性队列研究中，我们使用多变量回归和 Cox 比例风险模型比较了年龄在 15 至 44 岁之间有临床风湿性心脏病的女性与男性患者的合并症、死亡率、抗凝治疗使用率和治疗级联指标。我们纳入了 575 名女性和 252 名男性患者，中位年龄为 27 岁。20%的患者有心功能纽约心脏协会 III-IV 级心力衰竭。在有抗凝指征的患者中，女性接受华法林处方的可能性低于男性（66%比 81%；调整后的优势比，0.37；95%置信区间，0.14-0.96）。在这个年龄段，男性和女性的随访中（定义为前一年的就诊次数），保留在治疗中的比例都很差（男性为 27%，女性为 24%），但保留下来的患者的青霉素依从率很高（男性为 89%，女性为 92%）。男性的死亡率高于女性（中位随访 2.7 年期间，死亡率分别为 26%和 19%；调整后的风险比，1.66；95%置信区间，1.18-2.33）。
与男性相比，乌干达育龄期风湿性心脏病女性患者适当抗凝治疗的处方率较低，但死亡率也较低。在这个年龄段，男性和女性的随访中保留在治疗中的比例都很差，这是需要改进的一个关键目标。
