2020
DOI: 10.1161/jaha.119.015562
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Outcomes and Care Quality Metrics for Women of Reproductive Age Living With Rheumatic Heart Disease in Uganda

Abstract: 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 … Show more

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Cited by 10 publications
(19 citation statements)
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“…RHD prevalence among school children in SSA is 1.5% to 3.0%. [42][43][44][45][46][47] In RHD registries, only two-thirds of patients with an indication for oral anticoagulation received it, [5,37,48] and INR control was in-range in only 28%. [5] Venous thromboembolism (VTE) epidemiology in SSA has not been well described, [49] but HIV infection is a well-established risk factor, associated with a 1.5-fold increased hazard (95% confidence interval 1.1 to 2.0).…”
Section: {Figure 1 Here}mentioning
confidence: 99%
See 1 more Smart Citation
“…RHD prevalence among school children in SSA is 1.5% to 3.0%. [42][43][44][45][46][47] In RHD registries, only two-thirds of patients with an indication for oral anticoagulation received it, [5,37,48] and INR control was in-range in only 28%. [5] Venous thromboembolism (VTE) epidemiology in SSA has not been well described, [49] but HIV infection is a well-established risk factor, associated with a 1.5-fold increased hazard (95% confidence interval 1.1 to 2.0).…”
Section: {Figure 1 Here}mentioning
confidence: 99%
“…[29] In an analysis of the "care cascade" of RHD patients in Uganda, retention in care was the stage with the highest patient drop-out. [48] {Table 4 here}…”
Section: Patient-related Challengesmentioning
confidence: 99%
“…19 Another approach would include the decentralization of RHD care at specialized district level centers, as was done in Uganda. [20][21][22] Similarly, though injection pain was only cited by 5% of participants as the primary barrier to treatment adherence, it emerged as a major theme in focus group discussions. Because of the higher e cacy of BPG injections over oral penicillin equivalents for secondary prevention, however, this is unlikely to be addressed outside of providing analgesia to those patients.…”
Section: Discussionmentioning
confidence: 99%
“…[42][43][44][45][46][47] In rheumatic heart disease registries, only two-thirds of patients with an indication for oral anticoagulation received it. 5,37,48 Venous thromboembolism (VTE) epidemiology in SSA has not been well described, 49 but HIV infection is a well-established risk factor, associated with a 1.5-fold increased hazard (95% confidence interval 1.1 to 2.0). 50 As the HIV pandemic epicentre, HIV-associated 64 Warfarin is the most commonly used, followed by acenocoumarol.…”
Section: Changing Life Expectancy and Disease Burdenmentioning
confidence: 99%
“…64 In an analysis of the "care cascade" of rheumatic heart disease patients in Uganda, retention in care was the stage with the highest patient drop-out. 48 We are not aware of any studies reporting SSA patients' attitudes and beliefs about anticoagulation. A few studies (Table 5) reported on patients' anticoagulation knowledge, with generally low levels of knowledge found.…”
Section: Patient-related Challengesmentioning
confidence: 99%