Dynamics of quality of life parameters and echocardiography depending on adherence to treatment in patients with chronic rheumatic heart disease at 5-year follow-up

Aim. To assess the dynamics of quality of life indicators and echocardiography parameters depending on adherence to treatment in patients with chronic rheumatic heart disease at 5-year follow-up.

Material and methods. A total of 180 patients with RHD were examined. According to the Moriski-Green test 60% were not adherent to treatment; 28,9% are not sufficiently adherent; 11,1% — adherent to treatment. Echocardiography was performed on a Philips Affinity 50 machine, the quality of life was assessed using SF-36, KCCQ, MHFLQ.

Results. Both at baseline and after 5 years of observation, the maximum linear dimensions of left atrium — 4,90 [4,62;5,22] cm, left ventricle end-diastolic dimension — 5,55 [4,39;6,69] cm and left ventricle end-systolic dimension 3,70 [4,63;5,23] cm were in a group of adherent to treatment patients. The maximum dimensions of the right atrium (4,80 [4,55;5,15] cm) and of the right ventricle (2,70 [2,40;2,94]) cm at baseline and, after 5 years, were observed in group not adherent to treatment. Differences in the area of mitral valve between groups are not received. On the scales of quality of life, initially, the best value was in group of not sufficiently adherent: MHFLQ — 34,29 [26,97;40,3]; KCCQ functional status — 25,20 [19,28;31,18], KCCQ clinical summary score — 55,00 [47Д67.0]; SF-36 physical health — 34,26 [26,05;45,36], SF-36 mental health — 43,36 [37,49;48,60]. In the group of treatment adherents, the worst values of physical health SF-36 were 33,62 [32,5;36,92] and KCCQ clinical summary score was 37,50 [21,5;56,5]. After 5 years, in group of not sufficiently adherent patients maintained the best quality of life values: MHFLQ - 30,5 [11,5;48,5]; SF-36 physical health is 37,81 [31,51;45,91 ], KCCQ overall summary score — 24,85 [18,55;33,95]. Group of adherents to treatment had the best indicators of quality of life only for SF-36 mental health — 44,29 [30,47;58,33] and KCCQ clinical summary score — 67,50 [48,8;87,5].

Conclusion. In the study with RHD, there was no unambiguous effect of adherence to drug therapy on indicators of heart remodeling and quality of life. The data obtained on the greater severity of dilatation of left heart in adherents to treatment and dilatation of right in non-adherents require a comparison with patients who did not receive drug therapy and, possibly, a longer follow-up period.

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