European Journal of Cardiovascular Medicine

Rheumatic heart valve disease (RHVD) is a chronic sequel of acute rheumatic fever (ARF), predominantly affecting children and young adults in developing nations (1). It is a major contributor to global cardiovascular morbidity and mortality, with the burden highest in regions with limited access to primary healthcare services (2). The condition primarily results from an autoimmune response to group A beta-hemolytic streptococcal infection, leading to progressive valvular damage, particularly of the mitral and aortic valves (3).

The progression of RHVD can be insidious, often remaining asymptomatic until advanced stages, making early detection critical for effective management. Early diagnosis enables timely initiation of secondary prophylaxis, slows valvular deterioration, and reduces the incidence of heart failure and other complications (4,5). Conversely, delayed recognition often leads to irreversible structural damage, necessitating surgical intervention and increasing healthcare costs (6).

Advances in non-invasive diagnostic tools such as echocardiography have improved the ability to detect subclinical valve involvement (7). However, challenges persist in rural and resource-poor settings due to limited awareness, inadequate screening programs, and lack of trained personnel (8). Despite numerous efforts, the full potential of early diagnosis in improving long-term outcomes of RHVD remains underexplored.

This study aims to evaluate the impact of early diagnosis on clinical outcomes, treatment strategies, and prognosis in patients with rheumatic heart valve disease, highlighting the need for enhanced screening and early intervention strategies.

This prospective observational study was carried out in CVTS department, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow over a period of 18 months, from January 2023 to June 2024. The study received ethical clearance from the Institutional Ethics Committee, and written informed consent was obtained from all participants or their legal guardians.

A total of 120 patients diagnosed with rheumatic heart valve disease (RHVD) based on clinical history, physical examination, and echocardiographic findings were enrolled. Participants were aged between 10 and 60 years and were categorized into two groups:

• Group A (Early Diagnosis Group): Patients diagnosed with RHVD within 6 months of the onset of initial symptoms (n = 60).
• Group B (Delayed Diagnosis Group): Patients diagnosed after more than 6 months from symptom onset (n = 60).

Inclusion Criteria:

• Patients diagnosed with definite or borderline RHVD as per World Heart Federation criteria.
• Willingness to participate in follow-up visits.

Exclusion Criteria:

• Non-rheumatic causes of valvular heart disease.
• Patients with congenital heart defects, infective endocarditis, or previous valve surgeries.
• Individuals lost to follow-up during the study period.

All participants underwent a thorough clinical assessment, including detailed medical history, auscultation, and vital signs recording. Baseline investigations included electrocardiogram (ECG), chest X-ray, complete blood count, inflammatory markers (ESR, CRP), and transthoracic echocardiography. Follow-up evaluations were conducted every three months to monitor progression, treatment compliance, need for surgical intervention, and any hospital readmissions.

The primary outcome measures were improvement in clinical symptoms, requirement of surgical intervention (e.g., valve replacement or repair), hospital readmission rates, and survival at 12 months. Data were analyzed using SPSS software version 25. Continuous variables were expressed as mean ± standard deviation (SD), and categorical variables were presented as percentages. Statistical significance was determined using the chi-square test and independent t-test, with a p-value of <0.05 considered significant.

A total of 120 patients were included in the study and equally divided into two groups: Group A (early diagnosis, n=60) and Group B (delayed diagnosis, n=60). The demographic profile of patients is shown in Table 1. The mean age was 28.4 ± 9.2 years in Group A and 30.1 ± 10.5 years in Group B, with no statistically significant difference (p=0.31). Female patients constituted 58.3% in Group A and 61.7% in Group B.

Table 1. Baseline Demographic Characteristics of Study Participants

Clinical outcomes showed significant differences between the groups. As shown in Table 2, patients in Group A exhibited a higher rate of clinical improvement (82%) compared to Group B (53%) (p=0.002). Surgical intervention was required in only 12% of early-diagnosed patients versus 35% in the delayed diagnosis group (p=0.003).

Table 2. Clinical Outcomes in Group A vs. Group B

Moreover, the need for hospital readmission was substantially lower in the early diagnosis group (18%) than in the delayed group (44%), and the one-year survival rate was significantly higher in Group A (95%) compared to Group B (81%) (Table 2).

These findings suggest that early diagnosis of rheumatic heart valve disease contributes significantly to improved clinical outcomes, reduced complications, and better prognosis.

This study demonstrates that early diagnosis of rheumatic heart valve disease (RHVD) is strongly associated with better clinical outcomes, reduced need for surgical intervention, and lower hospital readmission rates. Patients diagnosed within six months of symptom onset showed significant improvements in management outcomes compared to those with delayed diagnosis.

The results align with existing literature emphasizing the value of early detection in the prevention of RHVD complications (1,2). Timely identification facilitates the initiation of secondary prophylaxis, which plays a critical role in halting the progression of valvular damage caused by repeated streptococcal infections (3,4). In our study, 82% of patients in the early diagnosis group responded well to medical management alone, suggesting that early-stage disease is more responsive to conservative treatment modalities.

Delayed diagnosis was associated with increased rates of valve replacement surgery (35%) and hospital readmissions (44%). These findings are consistent with previous studies indicating that late-stage RHVD is often complicated by irreversible fibrosis, calcification, and functional impairment of the valves, particularly the mitral and aortic valves (5-7). Consequently, surgical management becomes the only viable treatment option for such patients (8).

Echocardiography remains the cornerstone for the diagnosis and monitoring of RHVD. Studies have shown that even subclinical valvular lesions detected via Doppler echocardiography can predict disease progression and guide early intervention (9,10). Unfortunately, in many resource-limited settings, access to echocardiographic screening remains inadequate due to infrastructural and workforce constraints (11).

The significantly higher one-year survival rate (95%) in the early-diagnosed group compared to 81% in the delayed group further emphasizes the prognostic benefits of early detection. Similar survival benefits have been documented in other cohort studies, which reinforce the need for community-based screening and school health programs in endemic areas (12,13).

Furthermore, public awareness, adherence to antibiotic prophylaxis, and follow-up care are critical components in managing RHVD effectively (14). Health systems must integrate early diagnostic strategies into primary care settings, especially in countries with high RHVD prevalence (15).

Limitations of this study include a relatively small sample size and short follow-up duration. Additionally, being a single-center study, the findings may not be generalizable across broader populations. Future multi-center studies with longer follow-up periods are warranted to validate these outcomes and explore the cost-effectiveness of early diagnostic programs.

In conclusion, early diagnosis of RHVD significantly improves patient outcomes by enabling timely intervention, reducing the need for surgery, and enhancing survival. Strengthening diagnostic infrastructure and community-based screening initiatives is essential to reducing the global burden of this preventable disease.

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