Objective:

To understand the factors that influence rheumatic heart disease (RHD) patients' prosthetic heart valve choice, their knowledge of anticoagulation, and subsequent experience. This is the first RHD-specific data on valve choice, including high-deprivation populations.

Key Findings:

• 138 patients completed or partially completed the survey from a total sample of 218 patients; mean age was 49 ± 10.
• 61% of patients had bioprosthetic valves, while 39% had mechanical valves.
• Younger and older patients were more likely to have bioprosthetic valves, whereas middle-aged patients preferred mechanical valves.
• 44% of bioprosthetic valve patients specified warfarin avoidance as a reason for their choice.
• 62% of mechanical valve patients cited avoidance of reoperation as their primary reason for valve choice.
• 47% had not seen a dentist, and 34% had not followed up with a cardiologist post-operatively (based on different sample sizes).

Interpretation:

Surgeons and cardiologists significantly influenced valve choice among RHD patients, with many patients lacking follow-up care, which is a significant concern.

Limitations:

• The study was conducted at a single center, which may limit generalizability.
• The sample size was relatively small compared to the total number of patients eligible, potentially impacting the findings.

Conclusion:

A uniform evidence-based education programme for health professionals may enhance decision-making around valve choice. Additionally, free dental care and robust follow-up pathways would ensure this vulnerable group of patients is not lost to follow-up.