1
|
Coviello A, Cirillo D, Vargas M, de Siena AU, Barone MS, Esposito F, Izzo A, Buonanno P, Volpe S, Stingone AG, Iacovazzo C. Preoperative Echocardiographic Unknown Valvopathy Evaluation in Elderly Patients Undergoing Neuraxial Anesthesia during Major Orthopedic Surgery: A Mono-Centric Retrospective Study. J Clin Med 2024; 13:3511. [PMID: 38930041 PMCID: PMC11204530 DOI: 10.3390/jcm13123511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/31/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The assessment of cardiac risk is challenging for elderly patients undergoing major orthopedic surgery with preoperative functional limitations. Currently, no specific cardiac risk scores are available for these critical patients. Echocardiography may be a reliable and safe instrument for assessing cardiac risks in this population. This study aims to evaluate the potential benefits of echocardiography in elderly orthopedic patients, its impact on anesthesiologic management, and postoperative Major Adverse Cardiac Events (MACEs). Methods: This is a retrospective, one-arm, monocentric study conducted at ''Federico II'' Hospital-University of Naples-from January to December 2023, where 59 patients undergoing hip or knee revision surgery under neuraxial anesthesia were selected. The demographic data, the clinical history, and the results of preoperative Echocardiography screening (pEco-s) were collected. After extensive descriptive statistics, the χ2 test was used to compare the valvopathies and impaired Left Ventricular Function (iLVEF) prevalence before and after echocardiography screening and the incidence of postoperative MACE; a p-value < 0.05 was considered statistically significant. Results: The mean age was 72.5 ± 6.9, and the prevalence of cardiac risk factors was about 90%. The cumulative prevalence of iLVEF and valvopathy was higher after the screening (p < 0.001). The pEco-s diagnosed 25 new valvopathies: three of them were moderate-severe. No patients had MACE. Conclusions: pEco-s evaluation could discover unknown heart valve pathology; more studies are needed to understand if pEco-s could affect the anesthetic management of patients with functional limitations, preventing the incidence of MACE, and assessing its cost-effectiveness.
Collapse
Affiliation(s)
- Antonio Coviello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Dario Cirillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Andrea Uriel de Siena
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Maria Silvia Barone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Francesco Esposito
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Antonio Izzo
- Unit of Orthopedics and Traumatology, Department of Public Health, School of Medicine, “Federico II”—University of Naples, 80100 Naples, Italy;
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Serena Volpe
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Andrea Gabriele Stingone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| | - Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II”—University of Naples, 80100 Naples, Italy; (A.C.); (M.V.); (A.U.d.S.); (M.S.B.); (F.E.); (P.B.); (S.V.); (A.G.S.); (C.I.)
| |
Collapse
|
2
|
Klassen SL, Okello E, Ferrer JME, Alizadeh F, Barango P, Chillo P, Chimalizeni Y, Dagnaw WW, Eiselé JL, Eberly L, Gomanju A, Gupta N, Koirala B, Kpodonu J, Kwan G, Mailosi BGD, Mbau L, Mutagaywa R, Pfaff C, Piñero D, Pinto F, Rusingiza E, Sanni UA, Sanyahumbi A, Shakya U, Sharma SK, Sherpa K, Sinabulya I, Wroe EB, Bukhman G, Mocumbi A. Decentralization and Integration of Advanced Cardiac Care for the World's Poorest Billion Through the PEN-Plus Strategy for Severe Chronic Non-Communicable Disease. Glob Heart 2024; 19:33. [PMID: 38549727 PMCID: PMC10976983 DOI: 10.5334/gh.1313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/27/2024] [Indexed: 04/02/2024] Open
Abstract
Rheumatic and congenital heart disease, cardiomyopathies, and hypertensive heart disease are major causes of suffering and death in low- and lower middle-income countries (LLMICs), where the world's poorest billion people reside. Advanced cardiac care in these counties is still predominantly provided by specialists at urban tertiary centers, and is largely inaccessible to the rural poor. This situation is due to critical shortages in diagnostics, medications, and trained healthcare workers. The Package of Essential NCD Interventions - Plus (PEN-Plus) is an integrated care model for severe chronic noncommunicable diseases (NCDs) that aims to decentralize services and increase access. PEN-Plus strategies are being initiated by a growing number of LLMICs. We describe how PEN-Plus addresses the need for advanced cardiac care and discuss how a global group of cardiac organizations are working through the PEN-Plus Cardiac expert group to promote a shared operational strategy for management of severe cardiac disease in high-poverty settings.
Collapse
Affiliation(s)
- Sheila L. Klassen
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, United States
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, United States
| | - Emmy Okello
- Department of Medicine, Makerere University, Kampala, Uganda
| | | | - Faraz Alizadeh
- Department of Cardiology, Boston Children’s hospital, Boston, United States
- Department of Pediatrics, Harvard Medical School, Boston, United States
| | - Prebo Barango
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Pilly Chillo
- Muhimbili University of Health and Allied Sciences, Department of Internal Medicine, Dar Es Salaam, Tanzania
| | - Yamikani Chimalizeni
- Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Wubaye Walelgne Dagnaw
- Center for Integration Science, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, United States
| | | | - Lauren Eberly
- Division of Cardiovascular Medicine, Department of Medicine, Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, Penn Cardiovascular Center for Health, University of Pennsylvania, Philadelphia, United States
| | - Anu Gomanju
- Kathmandu Institute of Child Health, Kathmandu, Nepal
- Global Alliance for Rheumatic and Congenital Hearts, Philadelphia, United States
| | - Neil Gupta
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, United States
- Department of Global Health and Social Medicine, Program in Global NCDs and Social Change, Harvard University, Boston, United States
| | - Bhagawan Koirala
- Department of Cardiothoracic & Vascular Surgery – Manmohan Cardiothoracic Vascular and Transplant Centre, Kathmandu, Nepal
| | - Jacques Kpodonu
- Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, United States
| | - Gene Kwan
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, United States
- Partners In Health, Boston, United States
- Department of Global Health and Social Medicine, Harvard University, Boston, United States
| | | | | | - Reuben Mutagaywa
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Colin Pfaff
- Center for Integration Science, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, United States
| | - Daniel Piñero
- Departamento de Ecología Evolutiva, Instituto de Ecología, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Fausto Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Emmanuel Rusingiza
- Department of Pediatrics, Pediatric Cardiology Unit, University Teaching Hospital of Kigali, Kigali, Rwanda
- College of Medicine and Health Sciences, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Usman Abiola Sanni
- Partners in Health, Sierra Leone
- Department of Paediatrics, Federal Medical Centre, Birnin Kebbi, Nigeria
| | - Amy Sanyahumbi
- Pediatric Cardiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, United States
- Baylor Center of Excellence, Lilongwe, Malawi
| | - Urmila Shakya
- Pediatric Cardiology Department, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
- National Academy of Medical Sciences, Kathmandu, Nepal
| | - Sanjib Kumar Sharma
- Cardiology and Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Kunjang Sherpa
- Department of Cardiology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Isaac Sinabulya
- Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Emily B. Wroe
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, United States
| | - Gene Bukhman
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, United States
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, United States
- Department of Global Health and Social Medicine, Harvard University, Boston, United States
| | - Ana Mocumbi
- Universidade Eduardo Mondlane, Maputo, Mozambique
- Instituto Nacional de Saúde, Maputo, Mozambique
| |
Collapse
|
3
|
Santangelo G, Bursi F, Faggiano A, Moscardelli S, Simeoli PS, Guazzi M, Lorusso R, Carugo S, Faggiano P. The Global Burden of Valvular Heart Disease: From Clinical Epidemiology to Management. J Clin Med 2023; 12:2178. [PMID: 36983180 PMCID: PMC10054046 DOI: 10.3390/jcm12062178] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/23/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023] Open
Abstract
Valvular heart disease is a leading cause of cardiovascular morbidity and mortality and a major contributor of symptoms and functional disability. Knowledge of valvular heart disease epidemiology and a deep comprehension of the geographical and temporal trends are crucial for clinical advances and the formulation of effective health policy for primary and secondary prevention. This review mainly focuses on the epidemiology of primary (organic, related to the valve itself) valvular disease and its management, especially emphasizing the importance of heart valve centers in ensuring the best care of patients through a multidisciplinary team.
Collapse
Affiliation(s)
- Gloria Santangelo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesca Bursi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, 20122 Milan, Italy
| | - Andrea Faggiano
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Silvia Moscardelli
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, 20122 Milan, Italy
| | - Pasquale Simone Simeoli
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, 20122 Milan, Italy
| | - Marco Guazzi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, 20122 Milan, Italy
| | - Roberto Lorusso
- Cardiothoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), The Cardiovascular Research Institute Maastricht (CARIM), 6229 ER Maastricht, The Netherlands
| | - Stefano Carugo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Pompilio Faggiano
- Cardiothoracic Department Unit, Fondazione Poliambulanza, Via Leonida Bissolati 57, 25100 Brescia, Italy
| |
Collapse
|
4
|
Naing P, Kangaharan N, Scalia GM, Strange G, Playford D. Pulmonary hypertension in remote and disadvantaged population: overcoming unique challenges for improved outcomes. Intern Med J 2023; 53:12-20. [PMID: 35762199 PMCID: PMC10087585 DOI: 10.1111/imj.15860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/21/2022] [Indexed: 01/27/2023]
Abstract
Pulmonary hypertension (PH) is a common and debilitating medical condition with high mortality. PH research has traditionally focused on pulmonary arterial hypertension and its management in expert PH centres. Other forms of PH such as PH associated with cardiac or respiratory disease are more common, less well-understood and associated with higher mortality. Epidemiology of PH in disadvantaged, remote and rural regions, remains largely undocumented. In this review, we discuss the unique challenges in identifying PH in rural and disadvantaged populations using the Top End region of the Northern Territory of Australia as an example. We propose a simple diagnostic approach, ideally suited to regions where resource allocation is scarce, using clinical skills, echocardiography, and an escalation algorithm. The brief history, epidemiology and current literature on PH are summarised to inform the busy clinicians. We highlight two case examples from the Top End to illustrate the challenges and potential solutions.
Collapse
Affiliation(s)
- Pyi Naing
- University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Flinders University, Adelaide, South Australia, Australia.,The Prince Charles Hospital, Brisbane, Queensland, Australia.,Royal Darwin Hospital, Top End Health Service, Darwin, Northern Territory, Australia.,University of Queensland, Brisbane, Queensland, Australia
| | - Nadarajah Kangaharan
- Flinders University, Adelaide, South Australia, Australia.,Royal Darwin Hospital, Top End Health Service, Darwin, Northern Territory, Australia.,Northern Territory (NT) Cardiac Service, Darwin, Northern Territory, Australia
| | - Gregory M Scalia
- The Prince Charles Hospital, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
| | - Geoff Strange
- University of Notre Dame Australia, Fremantle, Western Australia, Australia.,University of Sydney, Sydney, New South Wales, Australia.,Heart Research Institute, Sydney, New South Wales, Australia
| | - David Playford
- University of Notre Dame Australia, Fremantle, Western Australia, Australia
| |
Collapse
|
5
|
Valvular Heart Disease Epidemiology. Med Sci (Basel) 2022; 10:medsci10020032. [PMID: 35736352 PMCID: PMC9228968 DOI: 10.3390/medsci10020032] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Valvular heart disease is a rapidly growing cause of global cardiovascular morbidity and mortality with diverse and evolving geographic distribution. The prevalence of rheumatic heart disease, the most common valvular heart disease (affecting approximately 41 million people), has been rising in developing nations, likely due to the expansion of the young adult population and the decrease in premature mortality that has resulted from improved access to antibiotics, microbiological testing, and echocardiography. Rheumatic heart disease has also been rising among the impoverished and, often, indigenous populations of developed nations, spurring public health initiatives that are aimed at alleviating healthcare disparities. Aortic valve stenotic disease is the most commonly occurring valvular pathology in developed nations (afflicting 9 million people worldwide) and its prevalence has been increasing with population aging and the increased prevalence of atherosclerosis. Aortic regurgitation is associated with diastolic, but not systolic, hypertension and it has likewise seen a rise in the developed world. Mitral regurgitation affects 24 million people worldwide, with great variability between and among nations. Primary mitral regurgitation arises as a consequence of myxomatous degeneration and mitral valve prolapse, which is largely due to genetic predispositions, while secondary mitral regurgitation accounts for 65% of cases and arises secondary to dilation and heart failure. Tricuspid regurgitation has become more prevalent in developed nations due to the increased usage of intracardiac pacemakers. Infective endocarditis prevalence has also grown in developed nations, likely due to population aging and the increased utilization of transcatheter valve replacement and prosthetic valves as interventions against the previously discussed valvular pathologies.
Collapse
|
6
|
Aliku TO, Rwebembera J, Lubega S, Zhang W, Lugero C, Namuyonga J, Omagino JOO, Okello E, Lwabi PS. Trends in Annual Incidence Rates of Newly Diagnosed Endomyocardial Fibrosis Cases at the Uganda Heart Institute: A 14-Year Review. Front Cardiovasc Med 2022; 9:841346. [PMID: 35498040 PMCID: PMC9051226 DOI: 10.3389/fcvm.2022.841346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/14/2022] [Indexed: 02/04/2023] Open
Abstract
BackgroundFirst described in Uganda over seven decades ago, Endomyocardial fibrosis (EMF) is a rare form of restrictive cardiomyopathy found in the tropics. EMF occurs mainly in two phenotypes; biventricular involvement and right ventricular (RV) form. Previously endemic in several countries, there are reports suggesting that the disease is on the decline.ObjectivesTo describe trends in annual incidence rates of newly diagnosed EMF cases at the Uganda Heart Institute (UHI).MethodsThis was a retrospective chart review of all newly diagnosed EMF cases at UHI from January 2007 to December 2020. Cases were divided into two groups A (2007–2013) and B (2014–2020).ResultsA total of 155 cases were diagnosed during the period (Group A, n = 124; Group B, n = 31). There were no significant differences between the two groups A and B regarding median age at diagnosis (14 vs. 12 years, p = 0.0940), gender (48.4% female vs. 35.5%, p = 0.1987), and EMF type (66.9% RV EMF vs. 71.0%, p = 0.6634), respectively. The presence of complications such as intracardiac thrombus (5.6 vs. 32.2%, p = 0.0002) and pericardial effusion (57.3% vs. 80.6, p = 0.0172) were more frequent in group B than A, respectively. Pulmonary hypertension (PHT) was predominantly seen in cases with biventricular EMF compared to those with RV EMF (26 vs. 3.8%, p = 0.0001). The number of new cases diagnosed per year remained largely stable in the period 2007–2011, ranging 14–21 per year, peaked in 2012 (26 new cases), and thereafter declined from 10 cases seen in 2013 to 1–5 cases seen per year in the period 2017–2020. Similarly, the annual incidence rates of new EMF diagnosis remained relatively stable in the period 2007–2012, ranging between 22.7 and 29.7 per 10,000 patients seen in the echo labs, and then dramatically declined after 2012 to range between 1.0 and 4.5 new cases per 10,000 patients in the period between 2017 and 2020.ConclusionThere has been a steady decline in the number of new cases of EMF seen at the UHI. However, there were no significant differences in the gender, age at diagnosis and EMF subtype of cases during the period under review. Complication rates were more frequent in the later cohort.
Collapse
Affiliation(s)
- Twalib Olega Aliku
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
- Uganda Christian University School of Medicine, Mukono, Uganda
- *Correspondence: Twalib Olega Aliku
| | | | - Sulaiman Lubega
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Wanzhu Zhang
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Charles Lugero
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Judith Namuyonga
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Emmy Okello
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | | |
Collapse
|
7
|
Shaddock L, Smith T. Potential for Use of Portable Ultrasound Devices in Rural and Remote Settings in Australia and Other Developed Countries: A Systematic Review. J Multidiscip Healthc 2022; 15:605-625. [PMID: 35378744 PMCID: PMC8976575 DOI: 10.2147/jmdh.s359084] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/17/2022] [Indexed: 02/02/2023] Open
Abstract
Introduction Objective Methods Results Conclusion
Collapse
Affiliation(s)
- Liam Shaddock
- Medical Radiation Science, School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Tony Smith
- The University of Newcastle Department of Rural Health & School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
- Correspondence: Tony Smith, The University of Newcastle Department of Rural Health, C/- 69A High Street, Taree, Newcastle, NSW, Australia, Tel +61 466 440 037, Email
| |
Collapse
|
8
|
Culliford-Semmens N, Tilton E, Wilson N, Stirling J, Doughty R, Gentles T, Peat B, Dimalapang E, Webb R. Echocardiography for latent rheumatic heart disease in first degree relatives of children with acute rheumatic fever: Implications for active case finding in family members. EClinicalMedicine 2021; 37:100935. [PMID: 34386737 PMCID: PMC8343257 DOI: 10.1016/j.eclinm.2021.100935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/30/2021] [Accepted: 05/13/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Individuals with Acute Rheumatic Fever (ARF) often report a family history of ARF or Rheumatic Heart Disease (RHD) however the degree of familial susceptibility to RHD is poorly defined. This study aimed to determine RHD prevalence among first degree relatives of ARF patients using echocardiography. METHODS Children with ARF were recruited from Auckland, New Zealand. Parents and siblings ≥ 4years were offered echocardiography. Echocardiograms were reported according to World Heart Federation 2012 criteria. RHD prevalence in first degree relatives was compared to previously established population rates in the region. FINDINGS In total, 70 index cases with ARF were recruited. Echocardiography was performed in 94 parents and 132 siblings. There were 3 siblings with definite RHD and 9 with borderline RHD. There were 4 parents with definite RHD. Overall prevalence of RHD (definite and borderline) in siblings was 90/1,000 (95% CI 45-143/1,000) compared to 36/1,000 (95% CI 30-42/1,000) in New Zealand children from high ARF incidence populations (p 0.001). Prevalence of definite RHD in parents was 42/1,000 (95% CI 7-87/1,000) compared to 22/1,000 (95% CI 9-36/1,000) in adults from a high ARF incidence New Zealand population (p 0.249). INTERPRETATION RHD prevalence in siblings and parents of ARF cases is significantly greater than in comparable background populations. The contribution of hereditary versus environmental risk factors remains uncertain. We recommend targeted echocardiographic case-finding among siblings and parents of ARF/RHD cases in order to detect previously unrecognized latent RHD.
Collapse
Affiliation(s)
- Nicola Culliford-Semmens
- Department of Paediatric and Congenital Cardiac Services, Starship Children's Hospital, New Zealand
| | - Elizabeth Tilton
- Department of Paediatric and Congenital Cardiac Services, Starship Children's Hospital, New Zealand
| | - Nigel Wilson
- Department of Paediatric and Congenital Cardiac Services, Starship Children's Hospital, New Zealand
| | - John Stirling
- Department of Paediatric and Congenital Cardiac Services, Starship Children's Hospital, New Zealand
| | - Robert Doughty
- Department of Medicine, University of Auckland, New Zealand
| | - Thomas Gentles
- Department of Paediatric and Congenital Cardiac Services, Starship Children's Hospital, New Zealand
| | - Briar Peat
- Department of Medicine, University of Auckland, New Zealand
- Middlemore Hospital, Counties Manukau District Health Board, New Zealand
| | - Eliazar Dimalapang
- Green Lane Cardiovascular Services, Auckland District Health Board, New Zealand
| | - Rachel Webb
- KidzFirst Children's Hospital, Counties Manukau District Health Board, New Zealand
- Department of Paediatric Infectious Diseases, Starship Children's Hospital, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, New Zealand
- Corresponding author at: KidzFirst Children's Hospital, Counties Manukau District Health Board, New Zealand.
| |
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW Pulmonary hypertension is a deadly disease, the causes of which vary between geographical regions. Eighty four percentage of the world's population lives in majority countries (also called low-income and middle-income countries), yet data on pulmonary hypertension in these settings are proportionally scarce. This article provides a review of pulmonary hypertension in majority countries, focusing in detail on the most common causes in these regions, and highlights contextual challenges faced. RECENT FINDINGS Epidemiological data confirms a complex and overlapping array of causes, with pulmonary hypertension because of conditions such as rheumatic heart disease, HIV, schistosomiasis, chronic lung disease and sickle cell disease. Delayed pulmonary hypertension diagnosis remains a concern and is ascribed to a lack of resources and lack of pulmonary hypertension awareness by health professionals. Pulmonary hypertension diagnosis is frequently considered once signs of right heart failure emerge, while echocardiography and right heart catheterization are unavailable in many settings. Accurate data on the prevalence of pulmonary hypertension in many of these regions are needed and could be achieved by establishing and frequent review of national databases where the incident and prevalent pulmonary hypertension cases are captured. SUMMARY There is urgent need for pulmonary hypertension advocacy among clinicians in the primary, secondary and tertiary healthcare sectors of majority countries, and validated noninvasive diagnostic algorithms are needed. Increased awareness and early diagnosis are likely to improve outcomes of pulmonary hypertension patients in these regions, and potentially stimulate locally relevant research.
Collapse
|
10
|
Vervoort D, Swain JD, Pezzella AT, Kpodonu J. Cardiac Surgery in Low- and Middle-Income Countries: A State-of-the-Art Review. Ann Thorac Surg 2021; 111:1394-1400. [DOI: 10.1016/j.athoracsur.2020.05.181] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/10/2020] [Accepted: 05/29/2020] [Indexed: 12/17/2022]
|
11
|
Wyber R, Wade V, Anderson A, Schreiber Y, Saginur R, Brown A, Carapetis J. Rheumatic heart disease in Indigenous young peoples. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:437-446. [PMID: 33705693 DOI: 10.1016/s2352-4642(20)30308-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/06/2020] [Accepted: 09/16/2020] [Indexed: 01/17/2023]
Abstract
Indigenous children and young peoples live with an inequitable burden of acute rheumatic fever and rheumatic heart disease. In this Review, we focus on the epidemiological burden and lived experience of these conditions for Indigenous young peoples in Australia, New Zealand, and Canada. We outline the direct and indirect drivers of rheumatic heart disease risk and their mitigation. Specifically, we identify the opportunities and limitations of predominantly biomedical approaches to the primary, secondary, and tertiary prevention of disease among Indigenous peoples. We explain why these biomedical approaches must be coupled with decolonising approaches to address the underlying cause of disease. Initiatives underway to reduce acute rheumatic fever and rheumatic heart disease in Australia, New Zealand, and Canada are reviewed to identify how an Indigenous rights-based approach could contribute to elimination of rheumatic heart disease and global disease control goals.
Collapse
Affiliation(s)
- Rosemary Wyber
- The George Institute for Global Health, Newtown, NSW, Australia.
| | - Vicki Wade
- RHDAustralia, Menzies School of Health Research, Darwin, NT, Australia
| | - Anneka Anderson
- Tomaiora Research Group, University of Auckland, Auckland, New Zealand
| | - Yoko Schreiber
- Section of Infectious Diseases, University of Manitoba, Clinical Sciences Division, Northern Ontario School of Medicine, ON, Canada
| | | | - Alex Brown
- South Australian Health and Medical Research Institute, University of Adelaide, SA, Australia
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia, Perth Children's Hospital, Perth, WA, Australia
| |
Collapse
|
12
|
Wyber R, Noonan K, Halkon C, Enkel S, Cannon J, Haynes E, Mitchell AG, Bessarab DC, Katzenellenbogen JM, Bond-Smith D, Seth R, D'Antoine H, Ralph AP, Bowen AC, Brown A, Carapetis JR. Ending rheumatic heart disease in Australia: the evidence for a new approach. Med J Aust 2020; 213 Suppl 10:S3-S31. [PMID: 33190287 DOI: 10.5694/mja2.50853] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
■The RHD Endgame Strategy: the blueprint to eliminate rheumatic heart disease in Australia by 2031 (the Endgame Strategy) is the blueprint to eliminate rheumatic heart disease (RHD) in Australia by 2031. Aboriginal and Torres Strait Islander people live with one of the highest per capita burdens of RHD in the world. ■The Endgame Strategy synthesises information compiled across the 5-year lifespan of the End Rheumatic Heart Disease Centre of Research Excellence (END RHD CRE). Data and results from priority research projects across several disciplines of research complemented literature reviews, systematic reviews and narrative reviews. Further, the experiences of those working in acute rheumatic fever (ARF) and RHD control and those living with RHD to provide the technical evidence for eliminating RHD in Australia were included. ■The lived experience of RHD is a critical factor in health outcomes. All future strategies to address ARF and RHD must prioritise Aboriginal and Torres Strait Islander people's knowledge, perspectives and experiences and develop co-designed approaches to RHD elimination. The environmental, economic, social and political context of RHD in Australia is inexorably linked to ending the disease. ■Statistical modelling undertaken in 2019 looked at the economic and health impacts of implementing an indicative strategy to eliminate RHD by 2031. Beginning in 2019, the strategy would include: reducing household crowding, improving hygiene infrastructure, strengthening primary health care and improving secondary prophylaxis. It was estimated that the strategy would prevent 663 deaths and save the health care system $188 million. ■The Endgame Strategy provides the evidence for a new approach to RHD elimination. It proposes an implementation framework of five priority action areas. These focus on strategies to prevent new cases of ARF and RHD early in the causal pathway from Streptococcus pyogenes exposure to ARF, and strategies that address the critical systems and structural changes needed to support a comprehensive RHD elimination strategy.
Collapse
Affiliation(s)
- Rosemary Wyber
- George Institute for Global Health, Sydney, NSW.,Telethon Kids Institute, Perth, WA
| | | | | | | | | | | | | | | | | | | | - Rebecca Seth
- Telethon Kids Institute, Perth, WA.,University of Western Australia, Perth, WA
| | | | | | - Asha C Bowen
- Telethon Kids Institute, Perth, WA.,Perth Children's Hospital, Perth, WA
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, SA.,University of South Australia, Adelaide, SA
| | | | | |
Collapse
|
13
|
Gregory AT, Stanton T, Thomas L, Selvanayagam JB, Robert Denniss A. Echocardiography: Navigating Complexities to Provide Many Useful Applications in Contemporary Clinical Cardiology. Heart Lung Circ 2019; 28:1303-1306. [PMID: 31352993 DOI: 10.1016/j.hlc.2019.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Tony Stanton
- Department of Cardiology, Sunshine Coast University Hospital, Brisbane, Qld, Australia; University of the Sunshine Coast, Brisbane, Qld, Australia; School of Medicine, Griffith University, Sunshine Coast University Hospital, Brisbane, Qld, Australia
| | - Liza Thomas
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Joseph B Selvanayagam
- College of Medicine, Flinders University, Adelaide, SA, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, SA, Australia; Cardiac Imaging Research, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - A Robert Denniss
- Heart Lung and Circulation, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Department of Cardiology, Blacktown Hospital, Western Sydney University, Australia
| |
Collapse
|