The Effect of Secondary Prophylaxis Adherence on Rheumatic Heart Disease and Determinants of Poor Adherence in Children: A 10-Year Retrospective Cohort Study.

Rheumatic heart disease (RHD) remains the leading cause of acquired cardiovascular morbidity and mortality in children. Since secondary prophylaxis is the cornerstone of the management of acute rheumatic fever (ARF) and RHD, this study aimed to assess the impact of prophylaxis adherence on disease recurrence and cardiac outcomes and to identify causes of non-adherence with prophylaxis. We retrospectively reviewed 137 ARF cases diagnosed before the age of 18 years, with a minimum follow-up duration of ≥ 6 months. Diagnosis was based on the Revised Jones criteria. Clinical and echocardiographic evaluations were conducted to assess RHD, and prophylaxis adherence was evaluated through qualitative interviews. The cohort (49% female, mean age 13.97 ± 3.69 years) had a 43.8% rate of cardiac involvement at diagnosis, decreasing to 40.9% at last follow-up, with 38% developing RHD. RHD development was significantly associated with initial carditis presence and worse severity (p = 0.001; p = 0.046). Adherence to secondary prophylaxis was observed in 88.3% (n = 121). Low socioeconomic status, milder valvulitis at diagnosis, and longer follow-up duration were associated with non-adherence (p = 0.008; 0.041; 0.001). Adherent patients showed significant reductions in both the number of affected valves (p = 0.001) and severity of valvular regurgitation (p = 0.003). Recurrence was more frequent among non-adherent patients (p = 0.005). Non-adherence to secondary prophylaxis remains a major barrier in ARF/RHD control, as it correlates with more severe valvular involvement and recurrence. Identifying factors influencing adherence may guide future strategies to improve both prophylaxis adherence and long-term outcomes.