• Narwani Hussin Clinical Research Center, Hospital Taiping
Keywords: rheumatic heart disease, registry, secondary prophylaxis


Background: Rheumatic heart disease is still endemic in developing countries and among the indigenous population in developed countries. However, there is no comprehensive data on rheumatic heart disease patients in Malaysia. The Cardiology Department of Queen Elizabeth ll Hospital, Sabah started this hospital-based registry in 2010. The objective of this analysis was to report the demographic profile, severity of disease, types of valve involvement and the practice of secondary prophylaxis among these patients.Method: Cross-sectional survey involved a three-year review of patients registered under the rheumatic heart disease registry in QEH ll, Sabah from December 2010 to November 2013. It included patients who attended the cardiology clinic who were diagnosed with rheumatic heart disease. Results: A total of 627 rheumatic heart disease patients were registered over a period of three years. Mean age was 41 (16.2) year old, 67.5% were female, and 51.2% of the patients had severe valvular dysfunction with mitral regurgitation as the commonest valve affected (67.3%). There was an increasing trend in the percentage of patients receiving secondary prophylaxis (oral and intra-muscular) from the year 2010 to the year 2013 (23.2% and 67.6% respectively). Abnormal ECG, pulmonary regurgitation and not on any secondary prophylaxis were found to be associated with severe rheumatic heart disease.Conclusion: Rheumatic heart disease is prevalent in Sabah. Most patients were had severe form of valve dysfunction when diagnosed. Awareness and advocacy on secondary prophylaxis warrant immediate improvement.


Carapetis JR., Steer AC., Mulholland EK. and Weber M. The Global Burden Of Group A Streptococcal Diseases. Lancet Infect Dis. 2005; 5: 685-94.

Seckeler MD. and Hoke TR. The Worldwide Epidemiology Of Acute Rheumatic Fever And Rheumatic Heart Disease. Clin Epidemiol. 2011; 3: 67-84.

Ibrahim A., Ismail Y., Mahendra R., Abdul Rashid AR. and Mustaffa E. Rheumatic Heart Disease in Malaysian school children: A prevalence study. 2nd International Heart Health Conference. Barcelona1995.

Omar A. Pattern of Acute Rheumatic Fever in a Local Teaching Hospital. Med J Malaysia 1995; Vol 50.

RHD Australia (ARF/RHD writing group) National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. The Australian Guideline for Prevention, Diagnosis and Management of Acute Rheumatic Fever and Rheumatic Heart Disease (2nd edition). 2012.

Bo Remenyi, Nigel Wilson, Andrew Steer, et al. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease - an evidence-based guidelines. Nature Reviews Cardiology. 2012; 9: 297-309.

World Heart Federation. Diagnosis and Management of Acute Rheumatic Fever and Rheumatic Heart Disease. 2007.

Sliwa K, Carrington M, Mayosi B, Zigiriadis E, Mvungi R and Stewart S. Incidence and characteristics of newly diagnosed rheumatic heart disease in Urban African adults: insights from the Heart of Soweto study. European Heart Journal. 2010; 31 (6): 719-27.

Parnaby MG. and Carapetis J.R. Rheumatic fever in Indigenous Australian Children. J Paediatr Child Health. 2010; 46: 527-33.

Kumar Vinay, Abbas Abul K, Fausto Nelson and Mitchell Richard N. Robbins Basic Pathology 8th ed. ed.: Saunders Elsevier, 2007, p. 403-6.

Lawrence JG, Carapetis Jonathan R., Griffiths K, Edwards K and Condon JR. Acute Rheumatic Fever and Rheumatic Heart Disease: Incidence and Progression in the Northern Territory of Australia, 1997 to 2010. Circulation. 2013; 128 (5): 492-501.

World Health Federation. Cardiovascular disease fact sheet.

Roberts K, Colquhoun S, Steer A, Remenyi B and Carapetis JR. Screening For Rheumatic Heart Disease: Current Approaches and Controversies. Nat Rev Cardiol. 2012; 10: 49-58.

Shrestha NR, Pilgrim T, Karki P, et al. Rheumatic heart disease revisited: patterns of valvular involvement from a consecutive cohort in eastern Nepal. Journal of Cardiovascular Medicine. 2012; 13 (11): 755-9.

WHO Expert Consultation on Rheumatic fever and Rheumatic heart disease. Rheumatic fever and rheumatic heart disease: a report of a WHO Expert Consultation, Geneva, 29 October-1 November 2001. Geneva, Switzerland: World Health Organization, 2004.

McDonald M., Brown A., Noonan S. and Carapetis JR. Preventing recurrent rheumatic fever : the role of register based programmes. Heart. 2005; 91: 1131-3.

Public Health Research Articles