Featured Publications
Outcomes and Care Quality Metrics for Women of Reproductive Age Living With Rheumatic Heart Disease in Uganda
Chang A, Nabbaale J, Okello E, Ssinabulya I, Barry M, Beaton A, Webel A, Longenecker C. Outcomes and Care Quality Metrics for Women of Reproductive Age Living With Rheumatic Heart Disease in Uganda. Journal Of The American Heart Association 2020, 9: e015562. PMID: 32295465, PMCID: PMC7428530, DOI: 10.1161/jaha.119.015562.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAge FactorsAnticoagulantsComorbidityFemaleHealthcare DisparitiesHumansMaleMedication AdherenceOutcome and Process Assessment, Health CareQuality Indicators, Health CareRegistriesReproductive HealthRetention in CareRetrospective StudiesRheumatic Heart DiseaseRisk AssessmentRisk FactorsSex FactorsTime FactorsTreatment OutcomeUgandaWomen's HealthYoung AdultConceptsRheumatic heart diseaseWomen of reproductive ageHeart diseaseReproductive ageClinical rheumatic heart diseaseRheumatic Heart Disease RegistryAdherence to guideline-based therapyNew York Heart Association class III-IV heart failurePrescription of warfarinRisk of cardiovascular complicationsCox proportional hazards modelsProportional hazards modelRetrospective cohort studyGuideline-based therapyAdherence ratesDisease RegistryCohort studyAnticoagulant prescriptionSub-Saharan AfricaAnticoagulant useCardiovascular complicationsClinical outcomesCompare comorbiditiesHazards modelHeart failureMotivations of women in Uganda living with rheumatic heart disease: A mixed methods study of experiences in stigma, childbearing, anticoagulation, and contraception
Chang A, Nabbaale J, Nalubwama H, Okello E, Ssinabulya I, Longenecker C, Webel A. Motivations of women in Uganda living with rheumatic heart disease: A mixed methods study of experiences in stigma, childbearing, anticoagulation, and contraception. PLOS ONE 2018, 13: e0194030. PMID: 29590159, PMCID: PMC5874006, DOI: 10.1371/journal.pone.0194030.Peer-Reviewed Original ResearchConceptsWomen of childbearing ageRheumatic heart diseaseFocus groupsLack of health system resourcesLimited health literacyQualitative descriptive methodologyHealth system resourcesHeart diseaseMixed methods studyMiddle-income countriesMale partnersChildbearing ageHealth literacyPatient empowermentWomen of reproductive ageAbandonment of patientsHealth programsPremature mortalitySide effects of contraceptivesDescriptive methodologyConsiderable stigmaIncreased risk of cardiovascular complicationsQualitative studyRisk of cardiovascular complicationsLMICs
2024
Preintervention Wait Time and Survival in People With Rheumatic Heart Disease in Uganda
Doh C, An C, Chang A, Rwebembera J, Mwambu T, Beaton A, Nakagaayi D, Ruda Vega P, Sable C, Longenecker C, Lwabi P. Preintervention Wait Time and Survival in People With Rheumatic Heart Disease in Uganda. The Annals Of Thoracic Surgery 2024, 118: 941-948. PMID: 38908768, DOI: 10.1016/j.athoracsur.2024.06.009.Peer-Reviewed Original ResearchRheumatic heart diseaseSurgical interventionRisk factors associated with timeClinical rheumatic heart diseaseFactors associated with timeAtrial fibrillationNew York Heart Association functional class III/IVYears of follow-upHeart diseaseCox proportional hazards modelsHistory of infective endocarditisHistory of atrial fibrillationMultivariate Cox proportional hazards modelFunctional class III/IVPre-interventionRight ventricular dysfunctionProportional hazards modelAssociated with increased probabilityProbability of deathEducation levelKaplan-Meier estimatesSurgical burdenPreoperative mortalityValve surgeryClass III/IVOutcomes and care quality metrics for people living with rheumatic heart disease and atrial fibrillation in Uganda
Opara C, Lan R, Rwebembera J, Okello E, Watkins D, Chang A, Longenecker C. Outcomes and care quality metrics for people living with rheumatic heart disease and atrial fibrillation in Uganda. Heart Rhythm O2 2024, 5: 201-208. PMID: 38690140, PMCID: PMC11056452, DOI: 10.1016/j.hroo.2024.02.002.Peer-Reviewed Original ResearchRheumatic heart diseaseCare retentionAtrial fibrillationFactors associated with retentionCare quality metricsNearest health centerNew York Heart Association functional class III/IVComplications of rheumatic heart diseaseLower-resource settingsHeart diseaseFunctional class III/IVMultivariate logistic regressionMedian follow-upCare metricsHealth centersPrescription ratesCareConcurrent AFAnticoagulant prescriptionLogistic regressionClass III/IVAF participantsMedian ageAtrial flutterCharacterize demographics
2023
Clinical Profile and Outcomes of Rheumatic Heart Disease Patients Undergoing Surgical Valve Procedures in Uganda
Rwebembera J, Chang A, Kitooleko S, Kaudha G, de Loizaga S, Nalule M, Ahabwe K, Zhang W, Okello E, Sinha P, Mwambu T, Sable C, Beaton A, Longenecker C. Clinical Profile and Outcomes of Rheumatic Heart Disease Patients Undergoing Surgical Valve Procedures in Uganda. Global Heart 2023, 18: 62. PMID: 38028964, PMCID: PMC10655755, DOI: 10.5334/gh.1260.Peer-Reviewed Original ResearchConceptsRheumatic heart diseaseAcute rheumatic feverComplication of acute rheumatic feverHeart diseaseValve surgery proceduresPost-operative survivalCohort of patientsProportion of patientsOutcome of operated patientsRetrospective cohort studyFifteen-year survivalValvular heart diseaseChronic valvular heart diseaseLong-term complicationsMortality of patientsValve surgeryValve repairValvular operationsValve proceduresPublic health problemRe-operationValve replacementSurgical managementUgandan patientsValvular interventionsAbstract 14916: Clinical and Socioeconomic Factors Associated With Time to Surgery and Preoperative Mortality in Surgery-Eligible Patients With Rheumatic Valvular Heart Disease in Uganda
Doh C, An C, Chang A, Rwebembera J, Mwambu T, Beaton A, Nakagaayi D, Vega P, Sable C, Lwabi P, Longenecker C. Abstract 14916: Clinical and Socioeconomic Factors Associated With Time to Surgery and Preoperative Mortality in Surgery-Eligible Patients With Rheumatic Valvular Heart Disease in Uganda. Circulation 2023, 148: a14916-a14916. DOI: 10.1161/circ.148.suppl_1.14916.Peer-Reviewed Original ResearchRheumatic heart diseaseFactors associated with timeLikelihood of surgeryPreoperative mortalitySurgical indicationsAwaiting surgeryAtrial fibrillationIncreased likelihood of surgeryValvular rheumatic heart diseaseHistory of infective endocarditisHistory of atrial fibrillationMultivariate Cox proportional hazards modelAdvanced rheumatic heart diseaseHeart diseaseRate of surgical interventionRheumatic valvular heart diseaseNYHA class I/IISurgery-eligible patientsNYHA class III/IVMedian follow-upAssociated with increased mortalityTime to surgeryCohort of patientsReceipt of surgeryValvular heart diseaseWhat We Lost in the Fire: Endemic Tropical Heart Diseases in the Time of COVID-19.
Chang A, Zühlke L, Ribeiro A, Barry M, Okello E, Longenecker C. What We Lost in the Fire: Endemic Tropical Heart Diseases in the Time of COVID-19. American Journal Of Tropical Medicine And Hygiene 2023, 108: 462-464. PMID: 36746666, PMCID: PMC9978545, DOI: 10.4269/ajtmh.22-0514.Peer-Reviewed Original ResearchConceptsHeart diseaseMiddle-income countriesGlobal health equityCOVID-19 pandemicHealth equityHealth disparitiesHealthcare providersCare systemMalaria control initiativesRheumatic heart diseaseGroup of disordersControl statusCOVID-19Time of COVID-19Control initiativesFunding increasesEndomyocardial fibrosisSubstantial mortalityDiseaseEndemic illnessOutcomesChagas diseasePeopleCareHealthcare
2022
Recent Advances in the Rheumatic Fever and Rheumatic Heart Disease Continuum
Rwebembera J, Nascimento B, Minja N, de Loizaga S, Aliku T, dos Santos L, Galdino B, Corte L, Silva V, Chang A, Dutra W, Nunes M, Beaton A. Recent Advances in the Rheumatic Fever and Rheumatic Heart Disease Continuum. Pathogens 2022, 11: 179. PMID: 35215123, PMCID: PMC8878614, DOI: 10.3390/pathogens11020179.Peer-Reviewed Original ResearchRheumatic heart diseaseHuman immunodeficiency virusRheumatic feverLatent rheumatic heart diseaseManagement of rheumatic heart diseaseGroup A <i>Streptococcus</i>Burden of rheumatic heart diseaseSecondary antibiotic prophylaxisAntibiotic prophylaxisGAS pharyngitisEchocardiographic screeningImmunodeficiency virusDiagnostic strategiesHeart diseaseTertiary managementVaccine developmentMiddle-income countriesNarrative reviewDisease continuumRF/RHDDiseaseFeverGlobal eradicationInfectious diseasesRheumatism
2021
Clinical Outcomes, Echocardiographic Findings, and Care Quality Metrics for People Living With Human Immunodeficiency Virus (HIV) and Rheumatic Heart Disease in Uganda
Chang A, Rwebembera J, Bendavid E, Okello E, Barry M, Beaton A, Haeffele C, Webel A, Kityo C, Longenecker C. Clinical Outcomes, Echocardiographic Findings, and Care Quality Metrics for People Living With Human Immunodeficiency Virus (HIV) and Rheumatic Heart Disease in Uganda. Clinical Infectious Diseases 2021, 74: 1543-1548. PMID: 34382644, DOI: 10.1093/cid/ciab681.Peer-Reviewed Original ResearchConceptsHuman immunodeficiency virusRheumatic heart diseaseEchocardiographic findingsImmunodeficiency virusHeart diseaseClinical outcomesDiagnosis of human immunodeficiency virusPrescription ratesAge- and sex-matched cohortMedication prescription ratesLongitudinal outcomes of patientsCare quality metricsOutcomes of patientsMiddle-income countriesEpidemiology of patientsSex-matched cohortAll-cause mortalityStroke/transient ischemic attackRate of strokeMedian ageClinical careCardiovascular complicationsClinical characteristicsMultivariable adjustmentConcurrent diagnosis