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Urina-Jassir M, Jaimes-Reyes MA, Urina-Jassir D, Urina-Triana M, Urina-Triana M. The role of echocardiographic screening in reducing the burden of rheumatic heart disease in Latin America. Rev Panam Salud Publica 2023; 47:e158. [PMID: 38089109 PMCID: PMC10712574 DOI: 10.26633/rpsp.2023.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/07/2023] [Indexed: 03/08/2024] Open
Abstract
The objectives of this article are to reflect on the rationale behind the use of echocardiographic screening for rheumatic heart disease and to provide key recommendations about steps needed to implement and improve echocardiographic screening programs in Latin America. Rheumatic heart disease remains a public health problem affecting mainly low-income and lower-middle-income countries and populations. Latin America is an area with economic inequalities, and the epidemiology of rheumatic heart disease remains largely unknown. Echocardiographic screening is useful for updating the epidemiology and providing early diagnosis of the disease. We discuss different approaches used in successful echocardiographic screening programs worldwide and in Latin America. We then identify the key elements needed to establish successful echocardiographic screening programs in Latin America, including increased awareness and involvement from multiple sectors (e.g. the community, health care professionals, scientific organizations and public health entities), identification of areas in need, development of a plan and structure that include different screening approaches, and how to ensure appropriate follow up for those who screen positive.
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Affiliation(s)
- Manuel Urina-Jassir
- Department of MedicineBoston University Chobanian and Avedisian School of MedicineBostonUnited States of AmericaDepartment of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, United States of America
| | - Maria Alejandra Jaimes-Reyes
- Department of Internal MedicineMedStar Washington Hospital CenterWashington, D.C.United States of AmericaDepartment of Internal Medicine, MedStar Washington Hospital Center, Washington, D.C., United States of America
| | - Daniela Urina-Jassir
- Section of CardiologyJohn W. Deming Department of MedicineTulane University School of MedicineNew OrleansUnited States of AmericaSection of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, United States of America
| | - Manuel Urina-Triana
- Unidad de Epidemiología ClínicaCentro de Investigación en Ciencias de la VidaUniversidad Simón BolívarBarranquillaColombiaUnidad de Epidemiología Clínica, Centro de Investigación en Ciencias de la Vida, Universidad Simón Bolívar, Barranquilla, Colombia
| | - Miguel Urina-Triana
- Programa de CardiologíaFacultad de Ciencias de la SaludUniversidad Simón BolívarBarranquillaColombiaPrograma de Cardiología, Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Colombia
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Chang AY, Zühlke L, Ribeiro ALP, Barry M, Okello E, Longenecker CT. What We Lost in the Fire: Endemic Tropical Heart Diseases in the Time of COVID-19. Am J Trop Med Hyg 2023; 108:462-464. [PMID: 36746666 PMCID: PMC9978545 DOI: 10.4269/ajtmh.22-0514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/12/2022] [Indexed: 02/08/2023] Open
Abstract
The COVID-19 pandemic has profoundly influenced the effort to achieve global health equity. This has been particularly the case for HIV/AIDS, tuberculosis, and malaria control initiatives in low- and middle-income countries, with significant outcome setbacks seen for the first time in decades. Lost in the calls for compensatory funding increases for such programs, however, is the plight of endemic tropical heart diseases, a group of disorders that includes rheumatic heart disease, Chagas disease, and endomyocardial fibrosis. Such endemic illnesses affect millions of people around the globe and remain a source of substantial mortality, morbidity, and health disparity. Unfortunately, these conditions were already neglected before the pandemic, and thus those living with them have disproportionately suffered during the time of COVID-19. In this perspective, we briefly define endemic tropical heart diseases, summarizing their prepandemic epidemiology, funding, and control statuses. We then describe the ways in which people living with these disorders, along with the healthcare providers and researchers working to improve their outcomes, have been harmed by the ongoing COVID-19 pandemic. We conclude by proposing the path forward, including approaches we may use to leverage lessons learned from the pandemic to strengthen care systems for these neglected diseases.
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Affiliation(s)
- Andrew Y. Chang
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
- Stanford Cardiovascular Institute, Stanford University, Stanford, California
- Center for Innovation in Global Health, Stanford University, Stanford, California
| | - Liesl Zühlke
- South African Medical Research Council, Cape Town, South Africa
- Division of Paediatric Cardiology, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
- Cape Heart Institute, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Antonio Luiz P. Ribeiro
- Telehealth Center and Cardiology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Michele Barry
- Center for Innovation in Global Health, Stanford University, Stanford, California
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Emmy Okello
- Department of Adult and Pediatric Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Chris T. Longenecker
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
- Department of Global Health, University of Washington, Seattle, Washington
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Lv M, Jiang S, Liao D, Lin Z, Chen H, Zhang J. Global Burden of Rheumatic Heart Disease and its Association with Socioeconomic Development Status, 1990-2019. Eur J Prev Cardiol 2022; 29:1425-1434. [PMID: 35234886 DOI: 10.1093/eurjpc/zwac044] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022]
Abstract
AIMS Rheumatic heart disease (RHD) remains an important health issue, yet global attention to RHD is diminishing. The aim of this study was to investigate the global burden of RHD and its relationship with socioeconomic development status. METHODS AND RESULTS Data were obtained from Global Burden of Disease (GBD) 2019 database. Incidence, prevalence, disability-adjusted life years (DALYs), and deaths numbers and rates for RHD were extracted and stratified by sex, level of socio-demographic index (SDI), country, and territory. In addition, the burden of RHD was compared across age groups. From 1990-2019, the age-standardized incidence and prevalence rates of RHD increased by 14.4% (11.2%-17.0%) and 13.8% (11.0%-16.0%), respectively. Incidence and prevalence rates showed an increasing trend in low SDI and low-middle SDI locations, while high-middle SDI and high SDI locations showed a decreasing trend. The age-standardized DALYs and deaths rates of RHD decreased by 53.1% (46.4-60.0) and 56.9% (49.8%-64.7%), and this downward trend more prominent in high-middle SDI and middle SDI locations. In addition, the age of incidence and prevalence rate were concentrated between 5-24 years and 15-49 years, predominantly in poor regions, and RHD appeared to be more common in women than in men. CONCLUSION The burden of RHD is negatively correlated with socioeconomic development status. In particular, the burden of RHD among children, adolescents, and women of childbearing age in poorer regions requires more attention. Policymakers should use the 2019 GBD data to guide cost-effective interventions and resource allocation for RHD.
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Affiliation(s)
- Meina Lv
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, 350001 China
| | - Shaojun Jiang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, 350001 China
| | - Dongshan Liao
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, 350001 China
| | - Zhi Lin
- Department of Cardiovascular Surgery, Xiamen Cardiovascular Hospital Xiamen University, Xiamen, Fujian, 361000 China
| | - Haiyu Chen
- Department of Cardiovascular Surgery, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, 350001 China
| | - Jinhua Zhang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, 350001 China
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Calcific aortic valve stenosis and COVID-19: clinical management, valvular damage, and pathophysiological mechanisms. CARDIOLOGY PLUS 2022. [DOI: 10.1097/cp9.0000000000000001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Belay W, Dessie A, Ahmed H, Gedlu E, Mariyo A, Shehibo A, Tigabu Z, Aliyu MH, Soslow J. Secondary prevention of rheumatic heart disease in Ethiopia: a multicenter study. BMC Cardiovasc Disord 2022; 22:26. [PMID: 35109807 PMCID: PMC8809239 DOI: 10.1186/s12872-022-02473-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background Ethiopia has a high acute rheumatic fever (ARF) and rheumatic heart disease (RHD) prevalence, and to our knowledge, there are no data on the status of secondary prevention in children with RHD. This study describes the status of secondary RHD prevention. Methods A multicenter, prospective study was performed on children aged 5–17 years with RHD in Ethiopia. Good adherence was defined as at least 80% completion of benzathine penicillin (BPG) or oral Amoxicillin within the previous year. The primary outcome measure was adherence to prophylaxis, expressed as a proportion. Socio-demographics, severity of RHD, and ARF recurrence were evaluated. Results A total of 337 children with a mean age of 12.9 ± 2.6 years were included. The majority (73%) had severe aortic/mitral disease. Participants were on BPG (80%) or Amoxicillin (20%) prophylaxis. Female sex (P = 0.04) use of BPG (0.03) and shorter mean duration of prophylaxis in months (48.5 ± 31.5 vs. 60.7 ± 33, respectively, P < 0.008) predicted good adherence. Running out of medications (35%), interrupted follow-up (27%), and the COVID-19 pandemic (26%) were the most common reasons for missing prophylaxis. Recurrence of ARF was higher in participants on Amoxicillin compared with BPG (40% vs. 16%, P < 0.001) and in those with poor adherence compared with good adherence (36.8% vs. 17.9%, respectively, P = 0.005). Type and duration of prophylaxis (OR 0.5, CI = 0.24, 0.9, P = 0.02; OR = 1.1, CI = 1.1, 1.2, P = 0.04, respectively), and sex (OR = 1.9, CI = 1.1, 3.4, P = 0.03) were independent predictors of poor adherence. Conclusion Poor adherence is prevalent in Ethiopian children living with RHD. Amoxicillin is a suboptimal option for prophylaxis as its use is associated with lower adherence and a higher rate of ARF recurrence. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02473-4.
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Affiliation(s)
- Wubishet Belay
- Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way 5th Floor, Nashville, TN, 37232, USA.
| | | | - Hayat Ahmed
- Black Lion Specialized Referral Hospital, Addis Ababa University College of Medicine and Health Sciences, Addis Ababa, Ethiopia
| | - Etsegenet Gedlu
- Black Lion Specialized Referral Hospital, Addis Ababa University College of Medicine and Health Sciences, Addis Ababa, Ethiopia
| | - Abinet Mariyo
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abdulkadir Shehibo
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zemene Tigabu
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA
| | - Jonathan Soslow
- Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way 5th Floor, Nashville, TN, 37232, USA
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Kaeley N, Chawang HJ, Baid H, Pillai A. Cardiovascular manifestations of COVID-19: A case series. J Family Med Prim Care 2021; 10:3930-3934. [PMID: 34934708 PMCID: PMC8653493 DOI: 10.4103/jfmpc.jfmpc_232_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19 is known to present with respiratory symptoms, which can lead to severe pneumonia and respiratory failure. However, it can have multisystem complications such as cardiovascular and neurological manifestations. Cardiovascular complications of SARS-CoV-2 infection are still underreported in India. We have compiled four cases received in our emergency department with different cardiovascular manifestations at presentation and were diagnosed with COVID-19. The cardiovascular manifestations reported by previous studies comprise myocarditis, cardiogenic shock, arrhythmias, pulmonary embolism, deep vein embolism, acute heart failure, and myocardial infarction. Hence, a thorough cardiac examination with ECG correlations and point of care cardiac markers should be done in all the patients with COVID-19 infection. Immediate initiation of prophylactic anticoagulation in COVID-19 hospitalized patients is mandatory. Geriatric patients and those with co-morbidities can have a fulminant course of illness; so our treatment protocol should be more vigilant in these patients. However, most importantly, we must not forget the significance of bedside echocardiography, lung ultrasound, and point of care markers.
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Affiliation(s)
- Nidhi Kaeley
- Department of Emergency Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Hannah J Chawang
- Department of Emergency Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Himanshi Baid
- Department of Emergency Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Aadya Pillai
- Department of Emergency Medicine, AIIMS, Rishikesh, Uttarakhand, India
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Kotit S, Phillips DIW, Afifi A, Yacoub M. The "Cairo Accord"- Towards the Eradication of RHD: An Update. Front Cardiovasc Med 2021; 8:690227. [PMID: 34277735 PMCID: PMC8282907 DOI: 10.3389/fcvm.2021.690227] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/07/2021] [Indexed: 01/18/2023] Open
Abstract
Rheumatic heart disease (RHD) is the most common cause of acquired heart disease in children and young adults. It continues to be prevalent in many low- and middle-income countries where it causes significant morbidity and mortality. Following the 2017 Cairo conference "Rheumatic Heart Disease: from Molecules to the Global Community," experts from 21 countries formulated an approach for addressing the problem of RHD: "The Cairo Accord on Rheumatic Heart Disease." The Accord attempts to set policy priorities for the eradication of acute rheumatic fever (ARF) and RHD and builds on a recent series of policy initiatives and calls to action. We present an update on the recommendations of the Cairo Accord and discuss recent progress toward the eradication of RHD, including contributions from our own Aswan Rheumatic Heart Disease Registry (ARGI).
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Affiliation(s)
| | - David I. W. Phillips
- Developmental Origins of Health and Disease Division, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | | | - Magdi Yacoub
- Aswan Heart Centre, Aswan, Egypt
- Heart Science Centre, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Tilve A, Mahajan NN, Pandey A, Jnanananda B, Gadekar S, Mahale SD, Gajbhiye RK. Impact of COVID-19 on pregnant women with Rheumatic heart disease or Peripartum cardiomyopathy. Eur J Obstet Gynecol Reprod Biol 2021; 258:459-461. [PMID: 33487485 PMCID: PMC7813491 DOI: 10.1016/j.ejogrb.2021.01.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/14/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Arundhati Tilve
- Department of Obstetrics and Gynaecology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, 400008, India
| | - Niraj N Mahajan
- Department of Obstetrics and Gynaecology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, 400008, India
| | - Ankita Pandey
- Department of Obstetrics and Gynaecology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, 400008, India
| | - Bhargavi Jnanananda
- Department of Obstetrics and Gynaecology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, 400008, India
| | - Sangram Gadekar
- Department of Obstetrics and Gynaecology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, 400008, India
| | - Smita D Mahale
- ICMR-National Institute for Research in Reproductive Health, Mumbai, 400012, India
| | - Rahul K Gajbhiye
- ICMR-National Institute for Research in Reproductive Health, Mumbai, 400012, India.
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