Evidence map›Paper›PMID 38365420›Full record

ArticleThe Lancet. Global health2024

Outcomes of rheumatic fever in Uganda: a prospective cohort study.

Scott H Wirth, Jafesi Pulle, JangDong Seo, Nicholas J Ollberding, Doreen Nakagaayi, Craig Sable, Asha C Bowen, Tom Parks, Jonathan Carapetis, Emmy Okello and 2 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet. Global health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
3.3field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 6 citations in OpenAlex.

  1. Review
  2. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 6 institutions in 4 countries.

Scott H WirthHeart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: scott.wirth@cchmc.org.
Jafesi PulleUganda Heart Institute, Kampala, Uganda.
JangDong SeoHeart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Nicholas J OllberdingDivision of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
Doreen NakagaayiUganda Heart Institute, Kampala, Uganda.
Craig SableChildren's National Medical Center, Washington, DC, USA.
Asha C BowenTelethon Kids Institute, University of Western Australia and Perth Children's Hospital, Nedlands, WA, Australia.
Tom ParksImperial College London, London, UK.
Jonathan CarapetisTelethon Kids Institute, University of Western Australia and Perth Children's Hospital, Nedlands, WA, Australia.
Emmy OkelloUganda Heart Institute, Kampala, Uganda.
Andrea BeatonHeart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Emma NdagireUganda Heart Institute, Kampala, Uganda.
Uganda Management Institute · UGThe Kids Research Institute Australia · AUChildren's National · USCincinnati Children's Hospital Medical Center · USImperial College London · GBUniversity of Cincinnati · US

Funding

Accelerating Delivery of rheumatic heart disease preventive iNterventions in Uganda (ADUNU)R01HL164615 · NHLBI · CINCINNATI CHILDRENS HOSP MED CTR · PI Andrea Zawacki Beaton, David A Watkins · 2022 to 2026
$3.0M
American Heart Association-American Stroke Association 17SFRN33670607NHLBI NIH HHS R01 HL164615Wellcome Trust
6 · The paper itself

Abstract

backgroundRheumatic heart disease is the largest contributor to cardiac-related mortality in children worldwide. Outcomes in endemic settings after its antecedent illness, acute rheumatic fever, are not well understood. We aimed to describe 3-5 year mortality, acute rheumatic fever recurrence, changes in carditis, and correlates of mortality after acute rheumatic fever.

methodsWe conducted a prospective cohort study of Ugandan patients aged 4-23 years who were diagnosed with definite acute rheumatic fever using the modified 2015 Jones criteria from July 1, 2017, to March 31, 2020, enrolled at three rheumatic heart disease registry sites in Uganda (in Mbarara, Mulago, or Lira), and followed up for at least 1 year after diagnosis. Patients with congenital heart disease were excluded. Patients underwent annual review, most recently in August, 2022. We calculated rates of mortality and acute rheumatic fever recurrence, tabulated changes in carditis, performed Kaplan-Meier survival analyses, and used Cox regression models to identify correlates of mortality.

findingsData were collected between Sept 1 and Sept 30, 2022. Of 182 patients diagnosed with definite acute rheumatic fever, 156 patients were included in the analysis. Of these 156 patients (77 [49%] male and 79 (51%) female; data on ethnicity not collected), 25 (16%) died, 21 (13%) had a cardiac-related death, and 17 (11%) had recurrent acute rheumatic fever over a median of 4·3 (IQR 3·0-4·8) years. 16 (24%) of the 25 deaths occurred within 1 year. Among 131 (84%) of 156 survivors, one had carditis progression by echo. Moderate-to-severe carditis (hazard ratio 12·7 [95% CI 3·9-40·9]) and prolonged PR interval (hazard ratio 4·4 [95% CI 1·7-11·2]) at acute rheumatic fever diagnosis were associated with increased cardiac-related mortality.

interpretationThese are the first contemporary data from sub-Saharan Africa on medium-term acute rheumatic fever outcomes. Mortality rates exceeded those reported elsewhere. Most decedents already had chronic carditis at initial acute rheumatic fever diagnosis, suggesting previous undiagnosed episodes that had already compounded into rheumatic heart disease. Our data highlight the large burden of undetected acute rheumatic fever in these settings and the need for improved awareness of and diagnostics for acute rheumatic fever to allow earlier detection.

fundingStrauss Award at Cincinnati Children's Hospital, American Heart Association, and Wellcome Trust.

Indexed as

MyocarditisRheumatic FeverRheumatic Heart DiseaseChildFemaleHumansMaleProspective StudiesUganda

Identifiers

PMID38365420
PMCPMC10882210
OpenAlexW4392145597

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.