Opara Chinonso C, Lan Roy H, Rwebembera Joselyn, Okello Emmy, Watkins David A, Chang Andrew Y, Longenecker Chris T
Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington.
Department of Medicine, Stanford University School of Medicine, California.
Heart Rhythm O2. 2024 Feb 15;5(4):201-208. doi: 10.1016/j.hroo.2024.02.002. eCollection 2024 Apr.
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.
We characterized demographics, treatment outcomes, and factors leading to care retention for participants with RHD and AF in Uganda.
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.
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, .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%, .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).
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.
心房颤动（AF）是风湿性心脏病（RHD）的常见并发症，在RHD仍然流行的资源匮乏地区，其治疗具有挑战性。
我们对乌干达患有RHD和AF的参与者的人口统计学特征、治疗结果以及导致持续接受治疗的因素进行了描述。
我们对2009年6月至2018年5月期间的乌干达国家RHD登记处进行了回顾性分析。纳入患有AF或心房扑动的参与者。将人口统计学特征、生存率和治疗指标与未患AF的参与者进行比较。采用多变量逻辑回归分析确定AF参与者中与持续接受治疗相关的因素。
共分析了1530名RHD参与者，其中293名（19%）患有AF。中位年龄为24岁（四分位间距14 - 38岁）。在中位随访203天（四分位间距98 - 275天）期间，两组的死亡率相似（调整后的风险比为1.183，95%置信区间为0.77）。共有79%的AF参与者接受了抗凝治疗，43%的人知道他们的目标国际标准化比值。AF参与者的持续治疗率更高（18%对12%，P = 0.01）。与持续治疗率降低相关的因素包括纽约心脏协会功能分级III/IV级（调整后的优势比[OR]为0.48，95%置信区间[CI]为0.30 - 0.76）以及到最近医疗中心的距离（调整后的OR为0.94，95% CI为0.90 - 0.99）。抗凝治疗处方与更高的持续治疗率相关（调整后的OR为1.86，95% CI为1.24 - 2.79）。
乌干达患有RHD和AF的参与者的死亡率并不高于未患AF的参与者。抗凝治疗处方率较高。尽管RHD参与者的持续治疗情况较差，但同时患有AF的参与者更有可能持续接受治疗。
