二级预防依从性对儿童风湿性心脏病的影响及依从性差的决定因素:一项10年回顾性队列研究

IF 1.4 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Ipek Ulkersoy, Fatih Karagozlu, Yusuf Iskender Coskun, Nujin Ulug Murt, Mehmet Yildiz, Fatih Haslak, Reyhan Dedeoglu, Ozgur Kasapcopur, Funda Oztunc
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引用次数: 0

摘要

风湿性心脏病(RHD)仍然是儿童获得性心血管疾病和死亡的主要原因。由于二级预防是急性风湿热(ARF)和RHD治疗的基石,本研究旨在评估坚持预防对疾病复发和心脏结局的影响,并确定不坚持预防的原因。我们回顾性分析了137例18岁前诊断的ARF病例,随访时间至少为6个月。诊断依据修订后的琼斯标准。通过临床和超声心动图评估RHD,并通过定性访谈评估预防依从性。该队列(49%为女性,平均年龄13.97±3.69岁)诊断时心脏受累率为43.8%,最后随访时降至40.9%,其中38%发展为RHD。RHD的发展与初始心炎的存在和更严重的程度显著相关(p = 0.001; p = 0.046)。88.3% (n = 121)的患者坚持二级预防。低社会经济地位、诊断时较轻的瓣膜炎和较长的随访时间与不依从性相关(p = 0.008; 0.041; 0.001)。粘附患者受影响的瓣膜数量(p = 0.001)和瓣膜反流严重程度(p = 0.003)均显著降低。非依从性患者复发率更高(p = 0.005)。不坚持二级预防仍然是控制ARF/RHD的主要障碍,因为它与更严重的瓣膜受累和复发有关。确定影响依从性的因素可以指导未来的策略,以改善预防依从性和长期结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Effect of Secondary Prophylaxis Adherence on Rheumatic Heart Disease and Determinants of Poor Adherence in Children: A 10-Year Retrospective Cohort Study.

Rheumatic heart disease (RHD) remains the leading cause of acquired cardiovascular morbidity and mortality in children. Since secondary prophylaxis is the cornerstone of the management of acute rheumatic fever (ARF) and RHD, this study aimed to assess the impact of prophylaxis adherence on disease recurrence and cardiac outcomes and to identify causes of non-adherence with prophylaxis. We retrospectively reviewed 137 ARF cases diagnosed before the age of 18 years, with a minimum follow-up duration of ≥ 6 months. Diagnosis was based on the Revised Jones criteria. Clinical and echocardiographic evaluations were conducted to assess RHD, and prophylaxis adherence was evaluated through qualitative interviews. The cohort (49% female, mean age 13.97 ± 3.69 years) had a 43.8% rate of cardiac involvement at diagnosis, decreasing to 40.9% at last follow-up, with 38% developing RHD. RHD development was significantly associated with initial carditis presence and worse severity (p = 0.001; p = 0.046). Adherence to secondary prophylaxis was observed in 88.3% (n = 121). Low socioeconomic status, milder valvulitis at diagnosis, and longer follow-up duration were associated with non-adherence (p = 0.008; 0.041; 0.001). Adherent patients showed significant reductions in both the number of affected valves (p = 0.001) and severity of valvular regurgitation (p = 0.003). Recurrence was more frequent among non-adherent patients (p = 0.005). Non-adherence to secondary prophylaxis remains a major barrier in ARF/RHD control, as it correlates with more severe valvular involvement and recurrence. Identifying factors influencing adherence may guide future strategies to improve both prophylaxis adherence and long-term outcomes.

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来源期刊
Pediatric Cardiology
Pediatric Cardiology 医学-小儿科
CiteScore
3.30
自引率
6.20%
发文量
258
审稿时长
12 months
期刊介绍: The editor of Pediatric Cardiology welcomes original manuscripts concerning all aspects of heart disease in infants, children, and adolescents, including embryology and anatomy, physiology and pharmacology, biochemistry, pathology, genetics, radiology, clinical aspects, investigative cardiology, electrophysiology and echocardiography, and cardiac surgery. Articles which may include original articles, review articles, letters to the editor etc., must be written in English and must be submitted solely to Pediatric Cardiology.
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