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Factors leading to poor adherence to secondar prophylaxis of rheumatic fever.

Session Poster Session 2

Speaker Romana Awan

Congress : ESC Preventive Cardiology (Formerly EuroPrevent) 2019

  • Topic : preventive cardiology
  • Sub-topic : Secondary Prevention
  • Session type : Poster Session
  • FP Number : P536

Authors : FAISAL Muhammad (Karachi,PK), ROMANA Romana (Karachi,PK), KANWAL Kanwal (Karachi,PK), SAMRA Faisal (Karachi,PK), SANIYA Saniya (Karachi,PK), MUSA Karim (Karachi,PK), FURNAZ Shumaila (Karachi,PK)

FAISAL Muhammad1 , ROMANA Romana1 , KANWAL Kanwal1 , SAMRA Faisal1 , SANIYA Saniya1 , MUSA Karim1 , FURNAZ Shumaila1 , 1National Institute of Cardiovascular Diseases (NICVD), Adult Cardiology - Karachi - Pakistan ,



Secondary prophylaxis of ARF with monthly injections of benzathine penicillin G is the only strategy which is considered to be effective at both community and population levels. However adherence to three- or four- weekly injections is variable. Several factors are responsible for patient’s non-compliance to the prescribed secondary prophylaxis. Hence it remains vital to identify these factors and propose an effective method to combat this issue.


To determine the level of adherence and possible barriers to secondary prophylaxis among diagnosed cases of Rheumatic heart disease.


This cross-sectional study was conducted at department of Adult Cardiology of our Institute. We included patients of either gender, age between 5 to 55 years, and diagnosed with Rheumatic heart disease on the basis of Transthoracic Echocardiography. Adherence and possible barriers to secondary prophylaxis were assessed using a structural questionnaire. Data was analyzed using SPSS version 21.


Baseline characteristics: Among total of 40 patients 70% (28) were female, mean age was 27.22 ± 13.58 years. Rural residents were 37.5% (15) and 55% (22) of the patients were illiterate.

Disease Severity: Mean duration since diagnosis of rheumatic fever was 67.88 ± 76.54 months. Mitral stenosis was observed in 62.5% (25) cases with 80% (20) having severe MS. Patients with mitral regurgitation were 72.5% (29) out of them 50% (14) had severe MR. Aortic stenosis was observed in 12.5% (5) of the patients and 20% (1) had severe AS. Patients with aortic regurgitation were 45% (18) out of them 7.1% (1) had severe AR. Tricuspid regurgitation was observed in 72.5% (29) of the patients and 34.5% (10) had severe TR.

Secondary Prophylaxis: Benzathine Penicillin injection was prescribed to 82.5% (33) patients, out of them 56.8% (21) of the patients were counseled regarding duration of secondary prophylaxis. 67.6% (25) patients had taken prophylaxis. Frequency of getting injections was once in 3 weeks in 38.5% (10), once in 4 weeks in 50% (13), once in 6 months in 7.7% (2), and once a year in 3.8% (1) patients. Only 40% (16) were still taking the Benzathine Penicillin Injection. Reason for not getting were reported to be Painful Injection (20.8%), Allergic Reaction (8.3%), No nearby health facility (12.5%), Injection not available at nearby facility (4.2%), Financial constraints (4.2%), Friends/Family advised otherwise (12.5%), Felt sick and unable to take injection (8.3%), Pregnancy (4.2%), and Lactation (4.2%).


Low adherence to the secondary prophylaxis was observed among diagnosed cases of rheumatic heart disease in our population. Reasons for non adherence for majority of the non adherent patients were painful injection, no nearby health facility, friends/family advised otherwise, allergic reaction, and felt sick and unable to take injection.

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