Effectivity and adherence of secondary prevention on clinical outcome of rheumatic heart disease in high-burden setting: a systematic review and meta-analysis

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Abstract Background Rheumatic heart disease (RHD) is often diagnosed late in low-resource settings due to limited health-seeking behavior and varied presentations. Optimal delivery of regular antibiotics prescribed as secondary prevention is vital to preventing disease progression. However, poor adherence of secondary prevention remains a significant challenge to these populations. Objective To assess the efficacy and adherence of patients to secondary prevention of rheumatic heart disease. Methods This systematic review and meta-analysis was carried out according to the PRISMA statement. Literature search was performed on four databases using keywords "Rheumatic heart disease", "secondary prevention", and their synonyms. Adherence and disease progression were the primary outcome. The overall proportion was estimated with R software (version 4.1.3) using a random-effects model of proportional meta-analysis. Results Thirteen studies were included in this study. Benzathine Penicillin G (BPG) injection every 4 weeks was the most common secondary prophylaxis regimen used. In 2052 patients, only 46% (27-66%) patients received >80% BPG prophylaxis injection. The effectiveness of secondary prophylaxis was powerful, evidenced by only 7% (2-12%) patients having disease progression of rheumatic heart disease. Conclusions BPG was found to be effective in the secondary prevention of rheumatic heart disease. Nonetheless, patient adherence to injection remains extremely low. Methods to improve patient adherence are imminently required.Figure 1Figure 2

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