Survival and mortality predictors among adults with rheumatic heart disease in ethiopia: a 10-year retrospective cohort study

Rheumatic heart disease (RHD) remains highly prevalent in low-income countries and is associated with severe complications and premature mortality. Limited local evidence in Ethiopia hinders understanding of disease progression and risk stratification. This study aimed to assess patterns of complications, survival, and predictors of mortality among adults with RHD in Ethiopia. We conducted a retrospective cohort study of 1,811 adults (≥ 18 years) with definite RHD diagnosed by transthoracic echocardiography according to the 2012 World Heart Federation criteria. Patients received care at the Cardiac Center of Ethiopia between January 1, 2015, and January 1, 2025. Complications and mortality were summarized descriptively. Survival was estimated using Kaplan–Meier methods and compared with log-rank tests. Independent predictors of mortality were identified using multivariable Cox proportional hazards regression. The median age was 32 years, with a female-to-male ratio of 1.5:1. Over a median follow-up of 5 years (IQR 2.5–6.5), 1,037 participants (57.3%) developed at least one complication, most commonly New York Heart Association (NYHA) class III–IV heart failure with pulmonary hypertension (31.4%) and isolated pulmonary hypertension (19.8%). A total of 326 participants (18.0%) died, with significantly lower survival among those with complications (p < 0.001). Independent predictors of mortality included presence of comorbidities (AHR 5.8), increased left ventricular internal diastolic diameter (LVIDd) (AHR 2.1), monthly income < 2,000 Ethiopian birr (≈ 13 USD) (AHR 1.2), NYHA class III–IV heart failure (AHR 2.2), and pulmonary hypertension (AHR 2.4). Adults with RHD in Ethiopia experience high rates of complications and premature mortality, driven by advanced heart failure, pulmonary hypertension, ventricular dilation, comorbidities, and socioeconomic disadvantage. Early detection, optimized chronic disease management, and expanded access to surgical and percutaneous interventions are urgently needed to improve outcomes in this resource-limited setting.