Laudari S, Consultant Cardiologist, Department of Cardiology, College of Medical Sciences-TH, Bharatpur, Nepal. E mail: lshankar2@hotmail.com
Background and Aims: Secondary prophylaxis has remained the mainstay of rheumatic fever and rheumatic heart disease management. Despite the proven ef????icacy and superiority of injectable penicillin in rheumatic heart disease patients, it has been underused in Nepal.
Materials and Methods: This is a hospital-based cross-sectional study from June 2014 to October 2018 over a period of 52 months at the College of Medical Sciences-Bharatpur including 350 patients with clinical and/or echocardiographic evidence of definite rheumatic heart disease. Data was collected from both cardiology outpatients and inpatients (admitted in cardioward/coronary care unit). Relevant data and information were entered into the pre-structured proforma and then analyzed by SPSS-16 software.
Results: The age of the patients ranged from 6 to 80 years with mean age 36.76±4.6years with female preponderance (F:M=1.26:1). The predominantly involved isolated valve was mitral in 152 patients (44.43%) followed by an aortic valve in 70 patients (20.00%) and the rest 90 (25.71%) had dual valvular involvement. The common complications encountered were heart failure in 200(57.14%) and arrhythmias in 155(44.29%) patients. Two hundred ten (60.00%) of the patients received penicillin (oral and injectable) and erythromycin. Majority 180/210=85.71%) were prescribed oral penicillin whereas only 46/210=21.90% received injectable penicillin; the ratio being 3.35:1.
Conclusion: RHD is a leading cause of heart failure and death among young population. There is underuse of penicillin with very minimal focus on use of injectable penicillins currently. Hence, Nepal government and other non-governmental organizations should consider implementation of use of penicillin broadly and moreover focus on use and adherence of injectable penicillin.
Keywords: Rheumatic Heart Disease, Penicillin, Underuse, Secondary Prophylaxis.
Rheumatic heart disease (RHD) is the most common cause of acquired heart disease in children and young adults globally and Nepal is not an exception to this. According to WHO, at least 15.6 million people worldwide have RHD [1] Of the 5,00,000 individuals who acquire acute rheumatic fever (ARF) every year, 3,00,000 go on to develop RHD and 2,33,000 deaths annually are attributable to ARF or RHD [1, 2]. Prevalence of RHD is even alarming in the young and adult population of rural South East Asian countries. Studies on RHD from diff erent parts of Nepal in the last two decades have shown the prevalence to vary from 1.2 to 4.35 per thousand in school aged children [3-5].