Liu C, Lai Y, Wu D, et al. - A median 5.9 year follow-up in patients suffering from rheumatic heart disease (RHD) revealed that treatment with renin–angiotensin–aldosterone system inhibitor (RAASi) was significantly related to reduced risks of mortality, heart failure (HF) rehospitalization, and new-onset atrial fibrillation (AF) in them.

• This retrospective study enrolled 734 RHD patients; of which 514 RHD patients were finally analysed following propensity score matching.

• Decreased risks of all-cause mortality, cardiovascular death (CVD), and cerebrovascular death were noted with RAASi treatment, with adjusted hazard ratios 0.52, 0.48, and 0.22, respectively.

• In cases managed surgically, there was a better impact on the risks of all-cause mortality and CVD except cerebrovascular death.

• RAASi treatment resulted in reduced HF rehospitalization risk of 1 year, 3 year, and 5 year, with adjusted odds ratio 0.38, 0.43, 0.48, respectively, as well as of new-onset AF risk (0.38).

• RAASi treatment was not associated with new-onset stroke risk.