Outcomes and care quality metrics for people living with rheumatic heart disease and atrial fibrillation in Uganda

BackgroundAtrial fibrillation (AF) is a common complication of rheumatic heart disease (RHD) and is challenging to treat in lower-resourced settings where RHD remains endemic.ObjectiveWe characterized demographics, treatment outcomes, and factors leading to care retention for participants with RHD and AF in Uganda.MethodsWe conducted a retrospective analysis of the Uganda national RHD registry between June 2009 and May 2018. Participants with AF or atrial flutter were included. Demographics, survival, and care metrics were compared to participants without AF. Multivariable logistic regression was used to identify factors associated with retention in care among participants with AF.Results1,530 participants with RHD were analyzed and 293 (19%) had AF. Median (IQR) age was 24 (14-38). Mortality was similar in both groups (adj HR 1.183, p=0.77) over a median (IQR) follow-up of 203 (98-275) days. 79% of AF participants were prescribed anticoagulation. 43% were aware of their target international normalized ratio (INR). Retention in care was higher in participants with AF (18% vs. 12%, p<0.01). Factors associated with decreased retention in care include NYHA class III/IV (adj OR 0.48, 95% CI 0.30-0.76) and distance to nearest health center (adj OR 0.94, 95% CI 0.90-0.99). Anticoagulation prescription was associated with enhanced care retention (adj OR 1.86, 95% CI 1.24-2.79).ConclusionParticipants with RHD and AF in Uganda do not suffer higher mortality than those without AF. Anticoagulation prescription rates are high. Although retention in care is poor among RHD participants, those with concurrent AF are more likely to be retained.