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Lee HJ, Cho I, Kim DY, Son JW, Choi KU, Lee S, Kim IC, Ko KY, Ha KE, Gwak SY, Kim K, Seo J, Kim H, Shim CY, Ha JW, Kim H, Hong GR, Narula J. Shifts in Clinical Characteristics, Treatment, and Outcome for Rheumatic Mitral Stenosis: Insights From a 20-Year Multicentre Registry Study in Korea. J Korean Med Sci 2024; 39:e152. [PMID: 38711317 DOI: 10.3346/jkms.2024.39.e152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND The rapid economic development of South Korea provides a unique model to study changes in the clinical characteristics, treatment approaches, and clinical outcomes of patients with rheumatic mitral stenosis (MS) relative to socioeconomic growth. METHODS From the Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) registry, 2,337 patients diagnosed with moderate or severe rheumatic MS between January 2001 and December 2020 were analyzed. Patients were grouped into consecutive 5-year intervals based on their year of diagnosis. Clinical characteristics, echocardiographic data, and clinical outcomes were assessed. RESULTS Over 20 years, the severity of mitral stenosis increased from 79.1% to 90.2%; similarly, the average age at diagnosis increased from 54.3 to 63.0 years (all P < 0.001). Comorbidities such as hypertension and atrial fibrillation increased (6.3% to 29.5% and 41.4% to 46.9%, respectively; all P for trend < 0.05). The rate of mitral intervention within five years after diagnosis increased from 31.2% to 47.4% (P for trend < 0.001). However, clinical outcomes of rheumatic mitral stenosis deteriorated over time in the composite outcomes (log-rank test, P < 0.001). Conversely, the incidence of stroke remained stable (60.6-73.7%; P < 0.001), which might be attributed to the increased use of anticoagulation therapy. CONCLUSION This study observed an increase in patient age, comorbidities, and valve disease severity as the country transitioned from a developing to developed status. Despite a rise in mitral valve interventions, clinical outcomes deteriorated over 20 years, highlighting the need for modified treatment approaches to improve patient outcomes.
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Affiliation(s)
- Hee Jeong Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dae-Young Kim
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Jang-Won Son
- Division of Cardiology, Yeungnam University Medical Center, Daegu, Korea
| | - Kang-Un Choi
- Division of Cardiology, Yeungnam University Medical Center, Daegu, Korea
| | - Seonhwa Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Kyu-Yong Ko
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Kyung Eun Ha
- Division of Cardiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Seo-Yeon Gwak
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jiwon Seo
- Department of Internal Medicine, Yonsei University Gangnam Severance Hospital, Seoul, Korea
| | - Hojeong Kim
- Division of Physiology, Department of Biomedical Laboratory, Daegu Health College, Daegu, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Brookes VJ, Henning CE, Worthing KA, Degeling C. Eliminate all risks: A call to reexamine the link between canine scabies and rheumatic heart disease. PLoS Negl Trop Dis 2024; 18:e0012115. [PMID: 38696362 PMCID: PMC11065235 DOI: 10.1371/journal.pntd.0012115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
Rheumatic heart disease (RHD) and acute rheumatic fever (ARF) disproportionately affect individuals in low-resource settings. ARF is attributed to an immune response to Group A Streptococcus (GAS) following GAS pharyngitis and potentially GAS impetigo in which infection can be initiated by scabies infestation. The burden of ARF and RHD in Aboriginal and Torres Strait Islander people in Australia is among the highest globally. Following recent calls to include dog management programs in ARF and RHD prevention programs, we believe it is timely to assess the evidence for this, particularly since previous recommendations excluded resources to prevent zoonotic canine scabies. While phylogenetic analyses have suggested that the Sarcoptes mite is host specific, they have differed in interpretation of the strength of their findings regarding species cross-over and the need for canine scabies control to prevent human itch. Given that there is also indication from case reports that canine scabies leads to human itch, we propose that further investigation of the potential burden of zoonotic canine scabies and intervention trials of canine scabies prevention on the incidence of impetigo are warranted. Considering the devastating impacts of ARF and RHD, evidence is required to support policy to eliminate all risk factors.
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Affiliation(s)
- Victoria J. Brookes
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
- Sydney Infectious Diseases Institute, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Caitlin E. Henning
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kate A. Worthing
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
- Sydney Infectious Diseases Institute, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Chris Degeling
- Australian Centre for Health Engagement, Evidence and Values, Faculty of the Arts, Social Sciences and the Humanities, University of Wollongong, Keiraville, New South Wales, Australia
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Choi M, Sempungu JK, Lee EH, Lee YH. Differential trends and patterns of sociodemographic disparities in burden of mental disorders, substance use disorder and self-harm across age groups: ecological study in 204 countries using the Global Burden of Disease Study 2019. BJPsych Open 2024; 10:e89. [PMID: 38639211 PMCID: PMC11060086 DOI: 10.1192/bjo.2024.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND It is well-known that socioeconomic status is associated with mental illness at both the individual and population levels, but there is a less clear understanding of whether socioeconomic development is related to poor mental health at the country level. AIMS We aimed to investigate sociodemographic disparities in burden of mental disorders, substance use disorders and self-harm by age group. METHOD Estimates of age-specific disability-adjusted life years (DALY) rates for mental disorders, substance use disorders and self-harm from 1990 to 2019 for 204 countries were obtained. The sociodemographic index (SDI) was used to assess sociodemographic development. Associations between burden of mental health and sociodemographic development in 1990 and 2019 were investigated, and sociodemographic inequalities in burden of mental health from 1990 to 2019 by age were estimated using the concentration index. RESULTS Differential trends in sociodemographic disparities in diseases across age groups were observed. For mental disorders, particularly depressive disorder and substance use disorders, DALY rates in high SDI countries were higher and increased more than those in countries with other SDI levels among individuals aged 10-24 and 25-49 years. By contrast, DALY rates for those over 50 years were lower in high SDI countries than in countries with other SDI levels between 1990 and 2019. A higher DALY rate among younger individuals accompanied a higher SDI at the country level. However, increased sociodemographic development was associated with decreased disease burden for adults aged ≥70 years. CONCLUSIONS Strategies for improving mental health and strengthening mental health system should consider a broader sociocultural context.
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Affiliation(s)
- Minjae Choi
- Institute for Future Public Health, Graduate School of Public Health, Korea University, Seoul, Republic of Korea; and Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Joshua Kirabo Sempungu
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea; and Program in Public Health, Graduate School, Korea University, Seoul, Republic of Korea
| | - Eun Hae Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea; and Program in Public Health, Graduate School, Korea University, Seoul, Republic of Korea
| | - Yo Han Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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Mao C, Sun X, Long D, Zhang M, Xu X, Gao X, Lin Y, Wang X. Epidemiological study of pediatric rheumatic heart disease: An analysis from the Global Burden of Disease Study 2019. Int J Cardiol 2024; 400:131705. [PMID: 38171386 DOI: 10.1016/j.ijcard.2023.131705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/29/2023] [Accepted: 12/29/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Rheumatic heart disease (RHD) is the most common acquired heart disease among children in developing countries. However, there is a lack of systematic studies on the epidemiology of pediatric RHD. This study aimed to report the burden of pediatric RHD at global, regional, and national levels between 1990 and 2019, which may provide some reference for policymakers. METHODS The numbers and age-standardized rates (ASRs) of incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for childhood RHD from 1990 to 2019 were analyzed based on data obtained from the Global Burden of Disease Study 2019 (GBD 2019). In addition, Joinpoint regression analysis was used to assess temporal trends in the burden of childhood RHD. RESULTS Globally, the number of incidence and prevalence cases of RHD in children increased by 41.89% and 40.88%, respectively, from 1990 to 2019. Age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) increased with an average annual percentage change (AAPC) of 0.75% and 0.66%, respectively. In contrast, the age-standardized DALY rate and age-standardized mortality rate (ASMR) decreased significantly since 1990 by an AAPC of -3.47% and - 2.65%, respectively. Girls had a significantly higher burden of RHD than boys during the study period. At the age level, the RHD burden was significantly highest in the age group of 10-14 years. Moreover, the ASRs of incidence, prevalence, mortality, and DALYs were negatively associated with sociodemographic index (SDI). Nationally, Fiji had the most significant increase in incidence and prevalence, and Philippines had the most remarkable rise in DALYs and mortality rates. CONCLUSION From 1990 to 2019, although the incidence and prevalence of childhood RHD increased globally, DALYs and mortality rates markedly reduced. Countries with lower levels of sociodemographic development shoulder a higher burden of childhood RHD. Children aged 10-14 years are critical populations for whom targeted measures are needed to reduce the RHD burden, while attention to girls cannot be neglected.
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Affiliation(s)
- Chenhan Mao
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China; Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Xuemei Sun
- Changzhou Hospital of Traditional Chinese Medicine, Changzhou, Jiangsu, China
| | - Dan Long
- The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Meng Zhang
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaojin Xu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China; Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Xin Gao
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China; Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Yan Lin
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China; Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu, China.
| | - Xindong Wang
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China; Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu, China.
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Osinski V, Yellamilli A, Firulyova MM, Zhang MJ, Peck A, Auger JL, Faragher JL, Marath A, Voeller RK, O’Connell TD, Zaitsev K, Binstadt BA. Profibrotic VEGFR3-Dependent Lymphatic Vessel Growth in Autoimmune Valvular Carditis. Arterioscler Thromb Vasc Biol 2024; 44:807-821. [PMID: 38269589 PMCID: PMC10978259 DOI: 10.1161/atvbaha.123.320326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Rheumatic heart disease is the major cause of valvular heart disease in developing nations. Endothelial cells (ECs) are considered crucial contributors to rheumatic heart disease, but greater insight into their roles in disease progression is needed. METHODS We used a Cdh5-driven EC lineage-tracing approach to identify and track ECs in the K/B.g7 model of autoimmune valvular carditis. Single-cell RNA sequencing was used to characterize the EC populations in control and inflamed mitral valves. Immunostaining and conventional histology were used to evaluate lineage tracing and validate single-cell RNA-sequencing findings. The effects of VEGFR3 (vascular endothelial growth factor receptor 3) and VEGF-C (vascular endothelial growth factor C) inhibitors were tested in vivo. The functional impact of mitral valve disease in the K/B.g7 mouse was evaluated using echocardiography. Finally, to translate our findings, we analyzed valves from human patients with rheumatic heart disease undergoing mitral valve replacements. RESULTS Lineage tracing in K/B.g7 mice revealed new capillary lymphatic vessels arising from valve surface ECs during the progression of disease in K/B.g7 mice. Unsupervised clustering of mitral valve single-cell RNA-sequencing data revealed novel lymphatic valve ECs that express a transcriptional profile distinct from other valve EC populations including the recently identified PROX1 (Prospero homeobox protein 1)+ lymphatic valve ECs. During disease progression, these newly identified lymphatic valve ECs expand and upregulate a profibrotic transcriptional profile. Inhibiting VEGFR3 through multiple approaches prevented expansion of this mitral valve lymphatic network. Echocardiography demonstrated that K/B.g7 mice have left ventricular dysfunction and mitral valve stenosis. Valve lymphatic density increased with age in K/B.g7 mice and correlated with worsened ventricular dysfunction. Importantly, human rheumatic valves contained similar lymphatics in greater numbers than nonrheumatic controls. CONCLUSIONS These studies reveal a novel mode of inflammation-associated, VEGFR3-dependent postnatal lymphangiogenesis in murine autoimmune valvular carditis, with similarities to human rheumatic heart disease.
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Affiliation(s)
- Victoria Osinski
- Department of Pediatrics and Center for Immunology, University of Minnesota, Minneapolis, MN
| | - Amritha Yellamilli
- Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA
- Medical Scientist Training Program, University of Minnesota, Minneapolis, MN
| | - Maria M. Firulyova
- Almazov National Medical Research Centre, Saint-Petersburg, Russia
- Computer Technologies Laboratory, ITMO University, Saint Petersburg, Russia
| | - Michael J. Zhang
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Alyssa Peck
- Department of Pediatrics and Center for Immunology, University of Minnesota, Minneapolis, MN
| | - Jennifer L. Auger
- Department of Pediatrics and Center for Immunology, University of Minnesota, Minneapolis, MN
| | - Jessica L. Faragher
- Department of Pediatrics and Center for Immunology, University of Minnesota, Minneapolis, MN
| | | | | | - Timothy D. O’Connell
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN
| | - Konstantin Zaitsev
- Computer Technologies Laboratory, ITMO University, Saint Petersburg, Russia
| | - Bryce A. Binstadt
- Department of Pediatrics and Center for Immunology, University of Minnesota, Minneapolis, MN
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Shimanda PP, Shumba TW, Brunström M, Iipinge SN, Söderberg S, Lindholm L, Norström F. Preventive Interventions to Reduce the Burden of Rheumatic Heart Disease in Populations at Risk: A Systematic Review. J Am Heart Assoc 2024; 13:e032442. [PMID: 38390809 PMCID: PMC10944073 DOI: 10.1161/jaha.123.032442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Rheumatic heart disease (RHD) is a devastating yet preventable condition that disproportionately affects low-middle-income countries and indigenous populations in some high-income countries. Various preventive interventions have been implemented across the globe, but evidence for the effectiveness of these measures in reducing the incidence or prevalence of acute rheumatic fever and RHD is scattered. This systematic review aims to assess the effectiveness of preventive interventions and identify the strategies used to reduce the burden of RHD. METHODS AND RESULTS A comprehensive search was conducted to identify relevant studies on RHD prevention interventions including interventions for primordial, primary, and secondary prevention. Effectiveness measures for the interventions were gathered when available. The findings indicate that school-based primary prevention services targeting the early detection and treatment of Group A Streptococcus pharyngitis infection with penicillin have the potential to reduce the incidence of Group A Streptococcus pharyngitis and acute rheumatic fever. Community-based programs using various prevention strategies also reduced the burden of RHD. However, there is limited evidence from low-middle-income countries and a lack of rigorous evaluations reporting the true impact of the interventions. Narrative synthesis was performed, and the methodological quality appraisal was done using the Joanna Briggs Institute critical appraisal tools. CONCLUSIONS This systematic review underscores the importance of various preventive interventions in reducing the incidence and burden of Group A Streptococcus pharyngitis, acute rheumatic fever, and RHD. Rigorous evaluations and comprehensive analyses of interventions are necessary for guiding effective strategies and informing public health policies to prevent and reduce the burden of these diseases in diverse populations. REGISTRATION URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42020170503.
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Affiliation(s)
| | - Tonderai W Shumba
- Department of Occupational Therapy and Physiotherapy University of Namibia Windhoek Namibia
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Cardiology Umeå University Umeå Sweden
| | | | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Cardiology Umeå University Umeå Sweden
| | - Lars Lindholm
- Department of Epidemiology and Global Health Umeå University Umeå Sweden
| | - Fredrik Norström
- Department of Epidemiology and Global Health Umeå University Umeå Sweden
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Ojha U, Marshall DC, Salciccioli JD, Al-Khayatt BM, Hammond-Haley M, Goodall R, Borsky KL, Crowley CP, Shalhoub J, Hartley A. Temporal trend analysis of rheumatic heart disease burden in high-income countries between 1990 and 2019. Eur Heart J Qual Care Clin Outcomes 2024; 10:108-120. [PMID: 36477873 PMCID: PMC10904725 DOI: 10.1093/ehjqcco/qcac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/29/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022]
Abstract
AIMS To assesses trends in rheumatic heart disease (RHD) burden in high-income, European Union 15+ (EU15+) countries between 1990 and 2019. METHODS AND RESULTS Cross-sectional analysis of the incidence and mortality of RHD was conducted using data from the Global Burden of Disease (GBD) Study database. Age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) were extracted for EU15+ countries per sex for each of the years from 1990 to 2019, inclusive, and mortality-to-incidence indices (MII) were computed. Joinpoint regression analysis was used for the description of trends. Over 29 years, an overall declining trend in RHD incidence and mortality across EU 15+ nations were observed. There was significant variability in RHD incidence and mortality rates across high-income countries. However, both RHD incidence and mortality were higher among females compared with males across EU15+ countries over the observed period. The most recent incidence trend, starting predominantly after 2014, demonstrated a rise in RHD incidence in most countries for both sexes. The timing of this RHD resurgence corresponds temporally with an influx of migrants and refugees into Europe. The recent increasing RHD incidence rates ranged from +0.4% to +24.7% for males, and +0.6% to +11.4% for females. CONCLUSION More than half of EU15+ nations display a recent increase in RHD incidence rate across both sexes. Possible factors associated with this rise are discussed and include increase in global migration from nations with higher RHD prevalence, host nation factors such as migrants' housing conditions, healthcare access, and migrant health status on arrival.
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Affiliation(s)
- Utkarsh Ojha
- Royal Brompton & Harefield Hospitals, Heart and Lung Division, Hill End Rd, Harefield, Uxbridge, UB9 6JH, UK
- Chelsea and Westminster Hospital, Department of Medicine, London SW10 9NH, UK
| | - Dominic C Marshall
- Department of Respiratory, National Heart and Lung Institute, Guy Scadding Building, Cale Street, London, SW3 6LY, UK
| | - Justin D Salciccioli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA
| | - Becker M Al-Khayatt
- Department of Cardiology, East Surrey Hospital, Surrey and Sussex NHS Trusts, UK
| | - Matthew Hammond-Haley
- Department of Cardiology, King's College Hospital, British Heart Foundation Centre of Research Excellence, London, WC2R 2LS, UK
| | - Richard Goodall
- St Andrews Centre for Plastic Surgery and Burns, Chelmsford, CM1 7ET, UK
| | - Kim L Borsky
- Department of Plastic Surgery, Stoke Mandeville Hospital, Mandeville Rd, Aylesbury, HP21 8AL, UK
| | - Conor P Crowley
- Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, 41 Burlington Mall Rd, Burlington, MA, USA
| | - Joseph Shalhoub
- Imperial College London and Imperial College Healthcare NHS Trust, Imperial Vascular Unit, Mary Stanford Wing, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - Adam Hartley
- Department of Cardiology, National Heart and Lung Institute, Imperial College London, London, SW7 2BX, UK
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Diniz MG, Fraga LL, Nunes MCP, Oliveira KKB, Amaral IB, Chavez LMT, de Paula LH, Haiashi BC, Ferreira AM, Silva MHA, Veloso JEM, Silva CA, Gelape FA, Santos LPA, Amaral AM, Coelho CT, Diamante LC, Correia JS, Meira ZMA, Ribeiro ALP, Spaziani AM, Sable C, Nascimento BR. Agreement between Handheld and Standard Echocardiography for Diagnosis of Latent Rheumatic Heart Disease in Brazilian Schoolchildren from High-Prevalence Settings (Agreement between Screening and Standard Echo for RHD). Diagnostics (Basel) 2024; 14:392. [PMID: 38396431 PMCID: PMC10888211 DOI: 10.3390/diagnostics14040392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
Introduction: Handheld echocardiography (echo) is the tool of choice for rheumatic heart disease (RHD) screening. We aimed to assess the agreement between screening and standard echo for latent RHD diagnosis in schoolchildren from an endemic setting. Methods: Over 14 months, 3 nonphysicians used handheld machines and the 2012 WHF Criteria to determine RHD prevalence in consented schoolchildren from Brazilian low-income public schools. Studies were interpreted by telemedicine by 3 experts (Brazil, US). RHD-positive children (borderline/definite) and those with congenital heart disease (CHD) were referred for standard echo, acquired and interpreted by a cardiologist. Agreement between screening and standard echo, by WHF subgroups, was assessed. Results: 1390 students were screened in 6 schools, with 110 (7.9%, 95% CI 6.5-9.5) being screen positive (14 ± 2 years, 72% women). Among 16 cases initially diagnosed as definite RHD, 11 (69%) were confirmed, 4 (25%) reclassified to borderline, and 1 to normal. Among 79 cases flagged as borderline RHD, 19 (24%) were confirmed, 50 (63%) reclassified to normal, 8 (10%) reclassified as definite RHD, and 2 had mild CHD. Considering the 4 diagnostic categories, kappa was 0.18. In patients with borderline RHD reclassified to non-RHD, the most frequent WHF criterion was B (isolated mitral regurgitation, 64%), followed by A (2 mitral valve morphological features, 31%). In 1 patient with definite RHD reclassified to normal, the WHF criterion was D (borderline RHD in aortic and mitral valves). After standard echo, RHD prevalence was 3.2% (95% CI 2.3-4.2). Conclusions: Although practical, RHD screening with handheld devices tends to overestimate prevalence.
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Affiliation(s)
- Marina G. Diniz
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (M.G.D.); (M.C.P.N.); (K.K.B.O.); (I.B.A.); (L.M.T.C.); (L.H.d.P.); (B.C.H.); (A.M.F.); (M.H.A.S.); (J.E.M.V.); (C.A.S.); (C.T.C.); (L.C.D.); (J.S.C.); (Z.M.A.M.); (A.L.P.R.)
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
| | - Lucas L. Fraga
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (M.G.D.); (M.C.P.N.); (K.K.B.O.); (I.B.A.); (L.M.T.C.); (L.H.d.P.); (B.C.H.); (A.M.F.); (M.H.A.S.); (J.E.M.V.); (C.A.S.); (C.T.C.); (L.C.D.); (J.S.C.); (Z.M.A.M.); (A.L.P.R.)
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
| | - Maria Carmo P. Nunes
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (M.G.D.); (M.C.P.N.); (K.K.B.O.); (I.B.A.); (L.M.T.C.); (L.H.d.P.); (B.C.H.); (A.M.F.); (M.H.A.S.); (J.E.M.V.); (C.A.S.); (C.T.C.); (L.C.D.); (J.S.C.); (Z.M.A.M.); (A.L.P.R.)
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
| | - Kaciane K. B. Oliveira
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (M.G.D.); (M.C.P.N.); (K.K.B.O.); (I.B.A.); (L.M.T.C.); (L.H.d.P.); (B.C.H.); (A.M.F.); (M.H.A.S.); (J.E.M.V.); (C.A.S.); (C.T.C.); (L.C.D.); (J.S.C.); (Z.M.A.M.); (A.L.P.R.)
| | - Ingred Beatriz Amaral
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (M.G.D.); (M.C.P.N.); (K.K.B.O.); (I.B.A.); (L.M.T.C.); (L.H.d.P.); (B.C.H.); (A.M.F.); (M.H.A.S.); (J.E.M.V.); (C.A.S.); (C.T.C.); (L.C.D.); (J.S.C.); (Z.M.A.M.); (A.L.P.R.)
| | - Luz Marina T. Chavez
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (M.G.D.); (M.C.P.N.); (K.K.B.O.); (I.B.A.); (L.M.T.C.); (L.H.d.P.); (B.C.H.); (A.M.F.); (M.H.A.S.); (J.E.M.V.); (C.A.S.); (C.T.C.); (L.C.D.); (J.S.C.); (Z.M.A.M.); (A.L.P.R.)
| | - Luiza Haikal de Paula
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (M.G.D.); (M.C.P.N.); (K.K.B.O.); (I.B.A.); (L.M.T.C.); (L.H.d.P.); (B.C.H.); (A.M.F.); (M.H.A.S.); (J.E.M.V.); (C.A.S.); (C.T.C.); (L.C.D.); (J.S.C.); (Z.M.A.M.); (A.L.P.R.)
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
| | - Beatriz C. Haiashi
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (M.G.D.); (M.C.P.N.); (K.K.B.O.); (I.B.A.); (L.M.T.C.); (L.H.d.P.); (B.C.H.); (A.M.F.); (M.H.A.S.); (J.E.M.V.); (C.A.S.); (C.T.C.); (L.C.D.); (J.S.C.); (Z.M.A.M.); (A.L.P.R.)
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
| | - Alexandre M. Ferreira
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (M.G.D.); (M.C.P.N.); (K.K.B.O.); (I.B.A.); (L.M.T.C.); (L.H.d.P.); (B.C.H.); (A.M.F.); (M.H.A.S.); (J.E.M.V.); (C.A.S.); (C.T.C.); (L.C.D.); (J.S.C.); (Z.M.A.M.); (A.L.P.R.)
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
| | - Mauro Henrique A. Silva
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (M.G.D.); (M.C.P.N.); (K.K.B.O.); (I.B.A.); (L.M.T.C.); (L.H.d.P.); (B.C.H.); (A.M.F.); (M.H.A.S.); (J.E.M.V.); (C.A.S.); (C.T.C.); (L.C.D.); (J.S.C.); (Z.M.A.M.); (A.L.P.R.)
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
| | - Jéssica Elvira M. Veloso
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (M.G.D.); (M.C.P.N.); (K.K.B.O.); (I.B.A.); (L.M.T.C.); (L.H.d.P.); (B.C.H.); (A.M.F.); (M.H.A.S.); (J.E.M.V.); (C.A.S.); (C.T.C.); (L.C.D.); (J.S.C.); (Z.M.A.M.); (A.L.P.R.)
| | - Cássia Aparecida Silva
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (M.G.D.); (M.C.P.N.); (K.K.B.O.); (I.B.A.); (L.M.T.C.); (L.H.d.P.); (B.C.H.); (A.M.F.); (M.H.A.S.); (J.E.M.V.); (C.A.S.); (C.T.C.); (L.C.D.); (J.S.C.); (Z.M.A.M.); (A.L.P.R.)
| | - Fernanda A. Gelape
- Curso de Medicina, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte 30130-110, MG, Brazil; (F.A.G.); (L.P.A.S.)
| | - Luiza P. A. Santos
- Curso de Medicina, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte 30130-110, MG, Brazil; (F.A.G.); (L.P.A.S.)
| | - Arthur M. Amaral
- Departamento de Medicina, Universidade Federal de Ouro Preto, Ouro Preto 35400-000, MG, Brazil;
| | - Cecília T. Coelho
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (M.G.D.); (M.C.P.N.); (K.K.B.O.); (I.B.A.); (L.M.T.C.); (L.H.d.P.); (B.C.H.); (A.M.F.); (M.H.A.S.); (J.E.M.V.); (C.A.S.); (C.T.C.); (L.C.D.); (J.S.C.); (Z.M.A.M.); (A.L.P.R.)
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
| | - Lucas C. Diamante
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (M.G.D.); (M.C.P.N.); (K.K.B.O.); (I.B.A.); (L.M.T.C.); (L.H.d.P.); (B.C.H.); (A.M.F.); (M.H.A.S.); (J.E.M.V.); (C.A.S.); (C.T.C.); (L.C.D.); (J.S.C.); (Z.M.A.M.); (A.L.P.R.)
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
| | - Juliane S. Correia
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (M.G.D.); (M.C.P.N.); (K.K.B.O.); (I.B.A.); (L.M.T.C.); (L.H.d.P.); (B.C.H.); (A.M.F.); (M.H.A.S.); (J.E.M.V.); (C.A.S.); (C.T.C.); (L.C.D.); (J.S.C.); (Z.M.A.M.); (A.L.P.R.)
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
| | - Zilda Maria A. Meira
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (M.G.D.); (M.C.P.N.); (K.K.B.O.); (I.B.A.); (L.M.T.C.); (L.H.d.P.); (B.C.H.); (A.M.F.); (M.H.A.S.); (J.E.M.V.); (C.A.S.); (C.T.C.); (L.C.D.); (J.S.C.); (Z.M.A.M.); (A.L.P.R.)
| | - Antonio Luiz P. Ribeiro
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (M.G.D.); (M.C.P.N.); (K.K.B.O.); (I.B.A.); (L.M.T.C.); (L.H.d.P.); (B.C.H.); (A.M.F.); (M.H.A.S.); (J.E.M.V.); (C.A.S.); (C.T.C.); (L.C.D.); (J.S.C.); (Z.M.A.M.); (A.L.P.R.)
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
| | - Alison M. Spaziani
- Cardiology, Children’s National Health System, Washington, DC 20010, USA; (A.M.S.); (C.S.)
| | - Craig Sable
- Cardiology, Children’s National Health System, Washington, DC 20010, USA; (A.M.S.); (C.S.)
| | - Bruno R. Nascimento
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (M.G.D.); (M.C.P.N.); (K.K.B.O.); (I.B.A.); (L.M.T.C.); (L.H.d.P.); (B.C.H.); (A.M.F.); (M.H.A.S.); (J.E.M.V.); (C.A.S.); (C.T.C.); (L.C.D.); (J.S.C.); (Z.M.A.M.); (A.L.P.R.)
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
- Serviço de Hemodinâmica, Hospital Madre Teresa, Belo Horizonte 30441-070, MG, Brazil
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9
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Kaewpechsanguan A, Chungsomprasong P, Durongpisitkul K, Vijarnsorn C, Chanthong P, Kanjanauthai S, Pacharapakornpong T, Thammasate P, Soongswang J. Manifestations of Rheumatic Carditis, Regression of Valvular Regurgitation, and Independent Predictors of Mitral Regurgitation Improvement After Rheumatic Carditis in Thai Children. Glob Heart 2024; 19:16. [PMID: 38344744 PMCID: PMC10854449 DOI: 10.5334/gh.1295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/12/2024] [Indexed: 02/15/2024] Open
Abstract
Background Acute rheumatic fever (ARF) with carditis can lead to the development of rheumatic heart disease in children and young adults. Objective This study aimed to investigate the manifestations of rheumatic carditis, clinically significant regression of valvular regurgitation as assessed by echocardiography, and the independent predictors of mitral regurgitation (MR) improvement after rheumatic carditis in Thai children. Method Children diagnosed with rheumatic carditis during 2005-2020 at Siriraj Hospital (Bangkok, Thailand) were retrospectively enrolled. Trivial, and mild regurgitation were grouped as non-clinically significant (NCS) regurgitation. Valvular regression was defined moderate-severe regurgitation improving to NCS regurgitation. Results Eighty-one patients (mean age: 10 years, range: 8-12 years) were included. At presentation, 59 (72.8%) patients had combined mitral regurgitation (MR) and aortic regurgitation (AR), 20 (24.6%) patients had MR alone, and 2 (2.4%) patients had AR alone. Concerning severity, 28 (34.6%) and 30 (37%) patients presented with severe and moderate MR, respectively. Severe and moderate AR was found in 9 (11.1%) and 16 (19.8%) patients, respectively. At the one-year follow-up, 43.4% of moderate-severe MR, and 41.7% of moderate-severe AR improved to NCS regurgitation. Multivariate analysis revealed high erythrocyte sedimentation rate (ESR) (p = 0.01) and severe carditis (p = 0.05) at presentation to be independent predictors of MR improvement. Conclusion Thai children with rheumatic carditis had a high incidence of valvular regurgitation; however, the valvular damage was improved in most patients. High ESR and severe carditis independently predict MR improvement.
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Affiliation(s)
- Araya Kaewpechsanguan
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Paweena Chungsomprasong
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kritvikrom Durongpisitkul
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chodchanok Vijarnsorn
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prakul Chanthong
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supaluck Kanjanauthai
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thita Pacharapakornpong
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ploy Thammasate
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jarupim Soongswang
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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McBenedict B, Mansoor Z, Chaudhary A, Thomas A, Yaseen M, Hauwanga W. Temporal Trends of Age-Adjusted Mortality Rates for Rheumatic Heart Disease in Brazil From 2000 to 2021. Cureus 2024; 16:e52322. [PMID: 38357062 PMCID: PMC10866569 DOI: 10.7759/cureus.52322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
Background Rheumatic heart disease (RHD) is a chronic cardiovascular condition stemming from an infectious origin, posing a substantial health burden, particularly in economically disadvantaged regions. It starts with acute rheumatic fever (ARF), a complication following group A Streptococcus infection, leading to heart valve damage and, over time, structural heart abnormalities. RHD contributes to premature deaths, especially in low-middle-income countries. Although the incidence and prevalence have generally reduced globally due to antibiotics and improved healthcare, it remains a significant public health concern in Brazil, echoing its prevalence in many developing nations around the world. RHD stands as a poignant testament to the intersection of socio-economic disparities and healthcare challenges within Brazil's diverse population. In Brazil, despite advancements in healthcare, RHD continues to impact communities, highlighting the urgent need for enhanced prevention strategies, access to quality healthcare services, and heightened awareness to combat this preventable, yet persistent, cardiac condition. Understanding the epidemiological landscape and socio-cultural factors influencing RHD in Brazil is crucial for developing targeted interventions aimed at mitigating its burden on individuals, families, and the healthcare system at large. Thus, our study focuses on analyzing age-related mortality rates linked to ARF and chronic RHD (ARHD) in Brazil from 2000 to 2021, particularly examining gender disparities. Materials and methods This retrospective cohort study employed a descriptive time-series approach, utilizing comprehensive nationwide data from Brazil spanning from 2000 to 2021 to assess trends in diverse age groups, among both sexes, enabling a detailed analysis of temporal patterns. Mortality data, extracted and categorized meticulously, were subjected to Joinpoint statistical analyses enabling comparative assessments, with average annual percent change (AAPC) and annual percent change (APC) serving as key metrics to quantify and interpret trends over the analyzed period. Results The acute RHD (ARHD)-related mortality declined over the analyzed years supported by AAPC, with higher mortality reduction in females. The age-adjusted mortality rate for "males and females" decreased from 78 to 67 deaths/100,000 from 2000 to 2021. Female mortality dropped from 85 to 69/100,000, and male mortality decreased from 73 to 63/100,000 over the same period. For ARHD, male age groups (20-29, 60-69, 70-79, 80+) showed declining mortality, while the 30-59 age group exhibited an upward. Females AAMR for chronic RHD (CRHD) decreased across all age groups, with significant reductions in the 80 years and above age group from 2000-2002 (APC: -11.94*) and steadily from 2002 onwards (APC: -1.33). Conclusions Our study revealed an overall decline in mortality rates for both acute and CRHD across both sexes. Females consistently exhibited higher mortality rates and a more pronounced reduction compared to males in both acute and CRHD. In ARHD, males experience the highest mortality in the 50-59 age group, while females have a peak in the 40-49 age group. The 60-69 age group had the highest mortality in CRHD for both sexes. Conversely, the 20-29 age group displayed the lowest mortality in CRHD, and the 80-89 age group had the lowest mortality in ARHD.
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Affiliation(s)
- Billy McBenedict
- Medicine, Hospital Universitário Antônio Pedro (Antonio Pedro University Hospital), Niteroi, BRA
| | - Zaeemah Mansoor
- Faculty of Health Sciences, Karachi Medical and Dental College, Karachi, PAK
| | | | - Anusha Thomas
- Neurology, Christian Medical College and Hospital, Ludhiana, IND
| | - Muhammad Yaseen
- Medicine and Surgery, Gambat Institute of Medical Sciences, Gambat, PAK
| | - Wilhelmina Hauwanga
- Family Medicine, Faculty of Medicine, Federal University of the State of Rio de Janeiro, Rio de Janeiro, BRA
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11
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Safiri S, Mousavi SE, Noori M, Nejadghaderi SA, Sullman MJM, Singh K, Kolahi AA. The burden of rheumatic heart disease in the Middle East and North Africa region, 1990-2019. Arch Cardiovasc Dis 2023; 116:542-554. [PMID: 37863752 DOI: 10.1016/j.acvd.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Rheumatic heart disease (RHD) is a treatable and preventable condition resulting from acute rheumatic fever. AIM To report the prevalence, mortality and disability-adjusted life-years (DALY) due to RHD in the Middle East and North Africa (MENA) region from 1990 to 2019, by sex, age group, country and sociodemographic index (SDI). METHODS Information on the prevalence, mortality and DALY associated with RHD were obtained from the Global Burden of Disease Study 2019. Data were gathered for all countries in the MENA region over the period 1990-2019. These data included counts and age-standardized rates per 100,000, accompanied by 95% uncertainty intervals (UIs). RESULTS The MENA region had an age-standardized point prevalence of 388.9 per 100,000 in 2019, which was 5.4% higher than in 1990. The annual incidence rate was 1.6, which was 63.4% lower than in 1990. There were 379.4 thousand DALY attributable to RHD in 2019, with an age-standardized rate of 67.1, which was 61.3% lower than in 1990. In 2019, an estimated 7.4 thousand deaths were due to RHD, and the age-standardized death rate was 63.4% lower in 2019 than in 1990. DALY rates rose steadily with increasing age in both males and females. The SDI correlated negatively with the rate of DALY for RHD throughout the study period. CONCLUSION The burden of RHD in MENA declined from 1990 to 2019, demonstrating the importance of regularly updating health data and identifying risk factors, and developing effective guidelines on prevention.
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Affiliation(s)
- Saeid Safiri
- Clinical Research Development Unit of Tabriz-Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran; Clinical Research Development Unit of Tabriz-Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Seyed Ehsan Mousavi
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Noori
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Aria Nejadghaderi
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran; Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mark J M Sullman
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus; Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Kuljit Singh
- Department of Cardiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia; Department of Medicine, Griffith University, Southport, Queensland, Australia
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid-Beheshti University of Medical Sciences, Tehran, Iran.
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12
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Minja NW, Pulle J, Rwebembera J, de Loizaga SR, Fall N, Ollberding N, Abrams J, Atala J, Kamarembo J, Oyella L, Odong F, Nalubwama H, Nakagaayi D, Sarnacki R, Su Y, Dexheimer JW, Sable C, Longenecker CT, Danforth K, Okello E, Beaton AZ, Watkins DA. Evaluating the implementation of a dynamic digital application to enable community-based decentralisation of rheumatic heart disease case management in Uganda: protocol for a hybrid type III effectiveness-implementation study. BMJ Open 2023; 13:e071540. [PMID: 37898491 PMCID: PMC10619093 DOI: 10.1136/bmjopen-2022-071540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 09/19/2023] [Indexed: 10/30/2023] Open
Abstract
INTRODUCTION Rheumatic heart disease (RHD) affects over 39 million people worldwide, the majority in low-income and middle-income countries. Secondary antibiotic prophylaxis (SAP), given every 3-4 weeks can improve outcomes, provided more than 80% of doses are received. Poor adherence is strongly correlated with the distance travelled to receive prophylaxis. Decentralising RHD care has the potential to bridge these gaps and at least maintain or potentially increase RHD prophylaxis uptake. A package of implementation strategies was developed with the aim of reducing barriers to optimum SAP uptake. METHODS AND ANALYSIS A hybrid implementation-effectiveness study type III was designed to evaluate the effectiveness of a package of implementation strategies including a digital, cloud-based application to support decentralised RHD care, integrated into the public healthcare system in Uganda. Our overarching hypothesis is that secondary prophylaxis adherence can be maintained or improved via a decentralisation strategy, compared with the centralised delivery strategy, by increasing retention in care. To evaluate this, eligible patients with RHD irrespective of their age enrolled at Lira and Gulu hospital registry sites will be consented for decentralised care at their nearest participating health centre. We estimated a sample size of 150-200 registrants. The primary outcome will be adherence to secondary prophylaxis while detailed implementation measures will be collected to understand barriers and facilitators to decentralisation, digital application tool adoption and ultimately its use and scale-up in the public healthcare system. ETHICS AND DISSEMINATION This study was approved by the Institutional Review Board (IRB) at Cincinnati Children's Hospital Medical Center (IRB 2021-0160) and Makerere University School of Medicine Research Ethics Committee (Mak-SOMREC-2021-61). Participation will be voluntary and informed consent or assent (>8 but <18) will be obtained prior to participation. At completion, study findings will be communicated to the public, key stakeholders and submitted for publication.
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Affiliation(s)
- Neema W Minja
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Kilimanjaro Clinical Research Institute (KCRI), Moshi, Tanzania, United Republic of
| | - Jafesi Pulle
- Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala, Uganda
| | - Joselyn Rwebembera
- Department of Adult Cardiology, Uganda Heart Institute Ltd, Kampala, Uganda
| | - Sarah R de Loizaga
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ndate Fall
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nicholas Ollberding
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jessica Abrams
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Reach, Cape Town, South Africa
| | - Jenifer Atala
- Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala, Uganda
| | - Jenipher Kamarembo
- Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala, Uganda
| | - Linda Oyella
- Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala, Uganda
| | - Francis Odong
- Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala, Uganda
| | - Haddy Nalubwama
- Department is Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Doreen Nakagaayi
- Department of Adult Cardiology, Uganda Heart Institute Ltd, Kampala, Uganda
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rachel Sarnacki
- Department of Cardiology, Children's National Medical Center, Washington, District of Columbia, USA
| | - Yanfang Su
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Judith W Dexheimer
- Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Craig Sable
- Department of Cardiology, Children's National Medical Center, Washington, District of Columbia, USA
| | - Chris T Longenecker
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Kristen Danforth
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Emmy Okello
- Department of Adult Cardiology, Uganda Heart Institute Ltd, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrea Zawacki Beaton
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David A Watkins
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of General Medicine, University of Washington, Seattle, Washington, USA
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Shi L, Bao C, Wen Y, Liu X, You G. Analysis and comparison of the trends in burden of rheumatic heart disease in China and worldwide from 1990 to 2019. BMC Cardiovasc Disord 2023; 23:517. [PMID: 37875798 PMCID: PMC10594932 DOI: 10.1186/s12872-023-03552-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023] Open
Abstract
OBJECTIVES This study aimed to describe the temporal trends in age and gender burdens of rheumatic heart disease (RHD) in China from 1990 to 2019, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs), and to compare them with the global burden of the disease. METHODS Using open data from the Global Burden of Disease (GBD) database from 1990 to 2019, this study analyzed the characteristics of RHD burden in China and worldwide, including changes in incidence, prevalence, mortality, and DALYs. Joinpoint was used to calculate the average annual percentage change (AAPC) and the corresponding 95% confidence interval (95% CI) to reflect the trends in the burden of RHD. A comprehensive comparative analysis of the differences in RHD burden between China and the rest of the world was conducted from multiple dimensions, including age, gender, and time periods. RESULTS From 1990 to 2019, the age-standardized incidence rate (ASIR) of RHD in China decreased from 29.62/100,000 to 23.95/100,000, while the global ASIR increased from 32.69/100,000 to 37.40/100,000. The age-standardized prevalence rate (ASPR) in China decreased from 446.15/100,000 to 390.24/100,000, while the global ASPR increased from 451.56/100,000 to 513.68/100,000. The age-standardized rates of mortality (ASMR) in China decreased from 18.11/100,000 to 4.04/100,000, while the global ASMR decreased from 8.94/100,000 to 3.85/100,000. The age-standardized DALY rate (ASDR) in China decreased from 431.45/100,000 to 93.73/100,000, while the global ASDR decreased from 283.30/100,000 to 132.88/100,000. The AAPC of ASIR, ASPR, ASMR, and ASDR in China was - 0.73%, -0.47%, -5.10%, and - 5.21%, respectively, while the AAPC of the global burden of RHD was 0.48%, 0.45%, -2.87%, and - 2.58%, respectively. The effects of age and gender on the burden of RHD were different. ASIR generally decreased with increasing age, while ASPR increased first and then decreased. ASMR and ASDR increased with increasing age. Women had higher incidence and mortality rates of RHD than men. CONCLUSION From 1990 to 2019, the incidence, prevalence, mortality, and DALYs of RHD in China decreased, indicating a relative reduction in the burden of RHD in China. The burden of RHD is age-related, with a higher prevalence observed in the younger population, a peak incidence among young adults, and a higher mortality rate among the elderly population. Women are more susceptible to RHD and have a higher risk of mortality than men. Given China's large population and aging population, RHD remains a significant public health challenge in China.
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Affiliation(s)
- Lang Shi
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, NO.37, Lane outside the southern, Chengdu, 610000, Sichuan, China
| | - Chenglu Bao
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, NO.37, Lane outside the southern, Chengdu, 610000, Sichuan, China
| | - Ya Wen
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, NO.37, Lane outside the southern, Chengdu, 610000, Sichuan, China
| | - Xuehui Liu
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, NO.37, Lane outside the southern, Chengdu, 610000, Sichuan, China
| | - Guiying You
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, NO.37, Lane outside the southern, Chengdu, 610000, Sichuan, China.
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Shimanda PP, Söderberg S, Iipinge SN, Lindholm L, Shidhika FF, Norström F. Health-related quality of life and healthcare consultations among adult patients before and after diagnosis with rheumatic heart disease in Namibia. BMC Cardiovasc Disord 2023; 23:456. [PMID: 37704961 PMCID: PMC10500941 DOI: 10.1186/s12872-023-03504-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Rheumatic Heart Disease (RHD) causes high morbidity and mortality rates among children and young adults, impacting negatively on their health-related quality of life (HRQoL). This study aimed to evaluate the HRQoL and healthcare consultations of adult patients with RHD in Namibia. METHODS From June 2019 to March 2020, a questionnaire was administered to 83 RHD patients during routine follow-ups. The EQ-5D-5L instrument was used to assess the health-related quality of life before diagnosis and at the time of the survey. The Ethiopian value set for EQ-5D-5L was used to calculate Quality-Adjusted Life Years (QALY). RESULTS Most respondents were women (77%), young adults below the age of 30 years (42%), and individuals who grew up in rural areas (87%). The mean QALY statistically significantly improved from 0.773 pre-diagnosis to 0.942 in the last 12 months (p < 0.001). Sixty-six patients who had surgery reported a better QALY. Healthcare visits statistically significantly increased from on average 1.6 pre-diagnosis to 2.7 days in the last 12 months (p < 0.001). The mean distance to the nearest facility was 55 km, mean cost of transport was N$65, and mean time spent at the clinic was 3.6 h. The median time from diagnosis to the survey was 7 years (quartiles 4 and 14 years). CONCLUSION Treatment and surgery can improve HRQoL substantially among RHD patients. Being diagnosed with RHD affects patients living in socioeconomically disadvantaged rural areas through cost and time for healthcare visits. It would be valuable with further research to understand differences between disease severities.
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Affiliation(s)
- Panduleni Penipawa Shimanda
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, SE, Sweden.
- Clara Barton School of Nursing, Welwitchia Health Training Centre, Pelican Square, P.O. Box 1835, Windhoek, Namibia.
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Cardiology, Umeå, SE, Sweden
| | - Scholastika Ndatinda Iipinge
- Clara Barton School of Nursing, Welwitchia Health Training Centre, Pelican Square, P.O. Box 1835, Windhoek, Namibia
| | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, SE, Sweden
| | | | - Fredrik Norström
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, SE, Sweden
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Walkinshaw DR, Wright MEE, Williams M, Scarapicchia TMF, Excler JL, Wiley RE, Mullin AE. A Strep A vaccine global demand and return on investment forecast to inform industry research and development prioritization. NPJ Vaccines 2023; 8:113. [PMID: 37558685 PMCID: PMC10412591 DOI: 10.1038/s41541-023-00690-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 05/30/2023] [Indexed: 08/11/2023] Open
Abstract
Investment in Strep A vaccine R&D is disproportionately low relative to the large burden of Strep A diseases globally. This study presents a novel Strep A vaccine global demand and financial forecast model with estimates of potential global demand and associated revenue and profits for a hypothetical Strep A vaccine as well as a net present value (NPV) analysis of return on capital investments required to develop the vaccine. A positive NPV was calculated for a variety of developer scenarios and target populations, including the global rollout of the vaccine in private and public markets by a multinational pharmaceutical corporation and a staged rollout by a developing country vaccine manufacturer for both infant and child populations. The results suggest there is a viable commercial market for a Strep A vaccine. It is hoped that this study will help to inform industry decision-making and drive increased prioritization of, and investment in, Strep A vaccine research and development.
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Shu S, Yang Y, Sun B, Su Z, Fu M, Xiong C, Zhang X, Hu S, Song J. Alerting trends in epidemiology for calcific aortic valve disease, 1990-2019: An age-period-cohort analysis for the Global Burden of Disease Study 2019. Eur Heart J Qual Care Clin Outcomes 2023; 9:459-473. [PMID: 36893802 PMCID: PMC10405136 DOI: 10.1093/ehjqcco/qcad018] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/20/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023]
Abstract
AIMS To assess the trends in calcific aortic valve disease (CAVD) epidemiology, with an emphasis on CAVD mortality, leading risk factors, and their associations with age, period, and birth cohort. METHODS AND RESULTS Prevalence, disability-adjusted life years, and mortality were derived from the Global Burden of Disease Study 2019. The age-period-cohort model was employed to study the detailed trends of CAVD mortality and its leading risk factors. Globally, CAVD showed unsatisfactory results from 1990 to 2019, with the CAVD deaths of 127 000 in 2019. CAVD mortality was substantially reduced in high socio-demographic index (SDI) countries [-1.45%, 95% confidence interval (CI) (-1.61 to -1.30)], mildly increased in high-middle SDI countries [0.22%, 95% CI (0.06-0.37)], and unchanged in other SDI quintiles. There was a noticeable transition in CAVD deaths from younger to older populations globally. The CAVD mortality increased exponentially with age, and the male had higher mortality than the female before 80 years old. Favourable period [0.69, 95% CI (0.66-0.72)] and birth effects [0.30, 95% CI (0.22-0.43)] were mainly observed in high SDI countries, while unfavourable effects were mostly noticed in high-middle SDI countries. High systolic blood pressure was the leading risk factor of CAVD deaths globally, and it showed favourable trends in high SDI regions. CONCLUSION Although CAVD mortality reduction was observed globally, unfavourable period, and cohort effects were found in many countries. Increase of mortality rate among the population ≥85 years was the common challenge across all SDI quintiles, stressing the necessity to further improve health care for CAVD patients worldwide.
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Affiliation(s)
| | | | | | - Zhanhao Su
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mengxia Fu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- The Cardiomyopathy Research Group, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Ruan R, Liu X, Zhang Y, Tang M, He B, Zhang QW, Shu T. Global, Regional, and National Advances Toward the Management of Rheumatic Heart Disease Based on the Global Burden of Disease Study 2019. J Am Heart Assoc 2023:e028921. [PMID: 37366108 DOI: 10.1161/jaha.122.028921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 06/02/2023] [Indexed: 06/28/2023]
Abstract
Background Population growth, aging, and major alterations in epidemiologic trends inadvertently modulate the status of rheumatic heart disease (RHD) epidemiology. This investigation predicted RHD burden pattern and temporal trends to provide epidemiologic evidence. Methods and Results Prevalence, mortality, and disability-adjusted life-years data for RHD were obtained from the GBD (Global Burden of Disease) study. We performed decomposition analysis and frontier analysis to assess variations and burden in RHD from 1990 to 2019. In 2019, there were >40.50 million RHD cases worldwide, along with nearly 0.31 million RHD-related deaths and 10.67 million years of healthy life lost to RHD. The RHD burden was commonly concentrated within lower sociodemographic index regions and countries. RHD primarily affects women (22.52 million cases in 2019), and the largest age-specific prevalence rate was at 25 to 29 years in women and 20 to 24 years in men. Multiple reports demonstrated prominent downregulation of RHD-related mortality and disability-adjusted life-years at the global, regional, and national levels. Decomposition analysis revealed that the observed improvements in RHD burden were primarily due to epidemiological alteration; however, it was negatively affected by population growth and aging. Frontier analysis revealed that the age-standardized prevalence rates were negatively linked to sociodemographic index, whereas Somalia and Burkina Faso, with lower sociodemographic index, showed the lowest overall difference from the frontier boundaries of mortality and disability-adjusted life-years. Conclusions RHD remains a major global public health issue. Countries such as Somalia and Burkina Faso are particularly successful in managing adverse outcomes from RHD and may serve as a template for other countries.
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Affiliation(s)
- Renjie Ruan
- Department of Cardiology The Third Affiliated Hospital of Wenzhou Medical University Wenzhou City Zhejiang Province China
| | - Xiaozhu Liu
- Department of Cardiology The Second Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Yunrui Zhang
- Department of Cardiology The Third Affiliated Hospital of Wenzhou Medical University Wenzhou City Zhejiang Province China
| | - Ming Tang
- Army Medical University (Third Military Medical University) Chongqing China
| | - Bo He
- Army Medical University (Third Military Medical University) Chongqing China
| | - Qing-Wei Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease Shanghai China
| | - Tingting Shu
- Army Medical University (Third Military Medical University) Chongqing China
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Liang Y, Yu D, Lu Q, Zheng Y, Yang Y. The rise and fall of acute rheumatic fever and rheumatic heart disease: a mini review. Front Cardiovasc Med 2023; 10:1183606. [PMID: 37288267 PMCID: PMC10242100 DOI: 10.3389/fcvm.2023.1183606] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/10/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction The incidences of acute rheumatic fever (ARF) and rheumatic heart disease (RHD), which were leading causes of death in children in the 1920s, have decreased substantially. Considering the recent resurgence of scarlet fever and increased incidence of streptococcal pharyngitis in children, an investigation of the current status of ARF and RHD may be worthwhile. Objective To summarize the prevalence trends, pathogenic factors, and prevention strategies for ARF and RHD in children. Methods A selective search of literature published between January 1920 and February 2023 was done in PubMed, using the terms "acute rheumatic fever", "rheumatic heart disease", "group A Streptococcus", "pharyngitis", "pharyngeal tonsillitis", "scarlet fever", "impetigo", "obstructive sleep apnea syndrome" and "child". Results Overcrowded homes and inadequate sanitation led to recurrent group A streptococcal infection, and the causal relationship between group A streptococcal infection and ARF/RHD was well established. Streptococcal infectious diseases, such as group A streptococcal pharyngeal tonsillitis, SF, impetigo, and obstructive sleep apnea syndrome, were associated with the occurrence of ARF and RHD. ARF and RHD were still prevalent in young people of developing countries and economically poor populations of high-income countries. Universal disease registration systems were critical to locating disease outbreaks, tracking disease transmission, and identifying high-risk populations. Four-level prevention strategies were effective in reducing the incidence and mortality of ARF and RHD. Conclusions Registry and preventive measures for ARF and RHD should be strengthened in areas of dense population; poor sanitation; resurgence of SF; and high incidence of streptococcal pharyngitis, impetigo, and obstructive sleep apnea syndrome.
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Affiliation(s)
- Yunmei Liang
- Department of Pediatrics, Beijing Chaoyang Hospital Affiliated to the Capital Medical University, Beijing, China
| | - Dingle Yu
- Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, China
| | - Qinghua Lu
- Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, China
- Microbiology Laboratory, National Center for Children’s Health, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Yuejie Zheng
- Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, China
| | - Yonghong Yang
- Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, China
- Microbiology Laboratory, National Center for Children’s Health, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, Beijing, China
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Parks T, Narube L, Perman ML, Sakumeni K, Fong JJ, Engelman D, Colquhoun SM, Steer AC, Kado J. Population-based assessment of cardiovascular complications of rheumatic heart disease in Fiji: a record-linkage analysis. BMJ Open 2023; 13:e070629. [PMID: 37094887 PMCID: PMC10152053 DOI: 10.1136/bmjopen-2022-070629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVE To determine population-based rates of non-fatal complications of rheumatic heart disease (RHD). DESIGN Retrospective cohort study based on multiple sources of routine clinical and administrative data amalgamated by probabilistic record-linkage. SETTING Fiji, an upper-middle-income country, where most of the population has access to government-funded healthcare services. PARTICIPANTS National cohort of 2116 patients with clinically apparent RHD aged 5-69 years during 2008 and 2012. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was hospitalisation for any of heart failure, atrial fibrillation, ischaemic stroke and infective endocarditis. Secondary outcomes were first hospitalisation for each of the complications individually in the national cohort as well as in hospital (n=1300) and maternity (n=210) subsets. Information on outcomes was obtained from discharge diagnoses coded in the hospital patient information system. Population-based rates were obtained using relative survival methods with census data as the denominator. RESULTS Among 2116 patients in the national cohort (median age, 23.3 years; 57.7% women), 546 (25.8%) were hospitalised for an RHD complication, a substantial proportion of all cardiovascular admissions in the country during this period in those aged 0-40 years (heart failure, 210/454, 46.3%; ischaemic stroke 31/134, 23.1%). Absolute numbers of RHD complications peaked during the third decade of life with higher population-based rates in women compared with men (incidence rate ratio 1.4, 95% CI 1.3 to 1.6, p<0.001). Hospitalisation for any RHD complication was associated with substantially increased risk of death (HR 5.4, 95% CI 3.4 to 8.8, p<0.001), especially after the onset of heart failure (HR 6.6, 95% CI 4.8 to 9.1, p<0.001). CONCLUSIONS Our study defines the burden of RHD-attributable morbidity in the general population of Fiji, potentially reflecting the situation in low-income and middle-income countries worldwide. Hospitalisation for an RHD complication is associated with markedly increased risk of death, re-emphasising the importance of effective early prevention.
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Affiliation(s)
- Tom Parks
- Department of Infectious Disease, Imperial College London, London, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Litia Narube
- Department of Obstetrics and Gynaecology, Fiji National University College of Medicine Nursing and Health Sciences, Suva, Rewa, Fiji
| | - Mai Ling Perman
- Department of Internal Medicine, Fiji National University College of Medicine Nursing and Health Sciences, Suva, Rewa, Fiji
| | - Kelera Sakumeni
- Fiji Ministry of Health and Medical Services, Suva, Rewa, Fiji
| | - James J Fong
- Fiji Ministry of Health and Medical Services, Suva, Rewa, Fiji
| | - Daniel Engelman
- Tropical Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Samantha M Colquhoun
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Andrew C Steer
- Tropical Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Joseph Kado
- Fiji Ministry of Health and Medical Services, Suva, Rewa, Fiji
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
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Rudiktyo E, Wind A, Doevendans P, Siswanto BB, Cramer MJ, Soesanto AM. Characteristics of patients with rheumatic heart disease in a national referral hospital in Indonesia. Med J Indones 2022. [DOI: 10.13181/mji.oa.226150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) is one of the most common cardiovascular problems in Indonesia. Comprehensive data regarding patient characteristics are critical in planning optimal treatment strategies to relieve the burden of RHD. This study aimed to describe the clinical and echocardiographic characteristics of patients across several types of valvular lesions in RHD in the Indonesian population.
METHODS This retrospective study was performed between January 2016 and June 2019 at the National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. The study population comprised all patients with significant valve disease aged ≥18 years. Patient characteristics and echocardiographic parameters were collected retrospectively from medical records and hospital information systems. Patients were classified into several groups based on etiologies of valve disease.
RESULTS Of 5,482 patients with significant valve lesions, 2,333 (42.6%) were RHD patients. They were predominantly female (64.1%) and younger (mean [standard deviation] age 42.61 [12.01] years). Atrial fibrillation (AF) was the most frequent rhythm disorder observed in RHD (65.4%). Isolated mitral stenosis was the most common valve lesion in RHD patients (46.5%). Most patients with RHD had preserved left ventricular (LV) ejection fraction. Half of the patients with mitral stenosis had reduced right ventricular (RV) contractility (tricuspid annular plane systolic excursion <17 mm).
CONCLUSIONS Isolated mitral stenosis was the most observed condition of valve lesions in RHD. Characteristics of RHD patients in this study were predominantly female, younger age, had preserved LV function, reduced RV function, and high prevalence of AF.
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