<![CDATA[Rheumatic heart disease (RHD) is a complication of acute rheumatic fever that can cause progressive damage to the heart valves. Secondary prophylaxis is given to prevent recurrence of rheumatic fever and slow the progression of valve damage. However, the relationship between adherence to secondary prophylaxis and heart valve disease in children with RHD remains unclear. To determine the relationship between adherence to secondary prophylaxis medication use and the severity of heart valve disease in children with RHD. This study used a retrospective cohort design conducted at Haji Adam Malik General Hospital, Medan. Subjects were pediatric patients aged <18 years with a diagnosis of RHD who visited the Pediatric Heart Clinic between June and December 2025, had undergone routine secondary prophylaxis therapy for at least one year, and had complete echocardiographic data. Patients with congenital heart defects or other heart diseases were excluded. Data were obtained from patient registries and medical records, including age, gender, age at diagnosis, initial echocardiography results, adherence to secondary prophylaxis medication, and the severity of valve abnormalities after one year of follow-up. Data were analyzed using statistical software using univariate and bivariate analyses with a significance level of p<0.05. The most common valve lesion was severe mitral regurgitation (57,4%), and the mitral valve was the most frequently involved valve in children with RHD. Adherence to secondary prophylaxis was quite good, with 61.7% of patients compliant and 38.3% non-compliant. The analysis showed that adherence to secondary prophylaxis medication was not significantly associated with changes in heart valve severity during one year of follow-up (p>0.05). Adherence to secondary prophylaxis did not significantly correlate with changes in heart valve severity in children with RHD, although most patients maintained stable valve conditions throughout the follow-up period.]]>
