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Ambari AM, Radi B, Dwiputra B, Arityanti D, Rikl T, Inggriani MP, Qhabibi FR, Susilowati E, Makes IK, Rudiktyo E, Cramer MJ, Doevendans P, Setianto B, Santoso A. Adherence to penicillin treatment is essential for effective secondary prevention of rheumatic heart disease: a systematic review and meta-analysis. Ann Med Surg (Lond) 2024; 86:2116-2123. [PMID: 38576943 PMCID: PMC10990302 DOI: 10.1097/ms9.0000000000001833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/04/2024] [Indexed: 04/06/2024] Open
Abstract
Background Penicillin is essential for secondary prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD). However, the incidences of ARF recurrence and RHD progression remain high, particularly in endemic countries. This meta-analysis evaluated the effectiveness of penicillin adherence in secondary prevention of ARF recurrence and RHD progression. Methods The authors included original articles employing an observational study design in which the study population included patients with ARF or RHD and documented adherence to secondary prophylaxis with penicillin for secondary prevention. Systematic searches of the PubMed, Scopus, and Cochrane databases were performed. Moreover, the authors also conducted a snowballing literature search from Europe PMC to expand the included studies. The quality of each study was assessed using the National Institute of Health Quality Assessment Tool. The statistical analyses were conducted using Review Manager 5.4.1 software developed by Cochrane. In addition, the authors utilized pooled odds ratios (ORs) to compare the adherence techniques. Results A total of 310 studies were identified, of which 57 full-text articles were assessed for eligibility. The authors included six studies with 1364 patients for the qualitative synthesis and meta-analysis. Good adherence to penicillin for the secondary prophylaxis of ARF and RHD, significantly reduced the odds of ARF recurrence or RHD progression by up to 71% compared to that associated with poor adherence [pooled OR 0.29 (0.21-0.40); I²=0% (p=0.56); Z=7.64 (p <0.00001)]. Conclusion Good adherence to penicillin for secondary prophylaxis in patients with ARF or RHD is essential for reducing the risk of ARF recurrence or RHD progression.
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Affiliation(s)
- Ade M. Ambari
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Basuni Radi
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Bambang Dwiputra
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dean Arityanti
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
| | - Thomas Rikl
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Maria P. Inggriani
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
| | - Faqrizal Ria Qhabibi
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
| | - Eliana Susilowati
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
| | - Indira Kalyana Makes
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
| | - Estu Rudiktyo
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | - Pieter Doevendans
- Department of Cardiology, University Medical Centre Utrecht
- Central Military Hospital, Netherlands Heart Institute, Utrecht, The Netherlands
| | - Budhi Setianto
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Anwar Santoso
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Torres RPDA, Torres RFDA, de Crombrugghe G, Moraes da Silva SP, Cordeiro SLV, Bosi KA, Smeesters PR, Torres RSLDA. Improvement of Rheumatic Valvular Heart Disease in Patients Undergoing Prolonged Antibiotic Prophylaxis. Front Cardiovasc Med 2021; 8:676098. [PMID: 34250039 PMCID: PMC8260676 DOI: 10.3389/fcvm.2021.676098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
Secondary prophylaxis of rheumatic heart diseases is efficient in reducing disease recurrence, heart damage, and cardiac impairment. We aimed to monitor the clinical evolution of a large Brazilian cohort of rheumatic patients under prolonged secondary prophylaxis. From 1986 to 2018, a cohort of 593 patients with rheumatic fever was followed every 6 months by the Reference Center for the Control and Prevention of Rheumatic Fever and Rheumatic Cardiopathy (CPCFR), Paraná, Brazil. In this cohort, 243 (41%) patients did not present cardiac damage (group I), while 350 (59%) were diagnosed with rheumatic heart disease (RHD) (group II) using the latest case definition. Among group II, 233 and 15 patients had impairment of the mitral and aortic valves, respectively, while 102 patients had impairment of both valves. Lesions on the mitral and aortic valves presented a regression in 69.9 and 48.7% of the patients, respectively. Active patient recruitment in the reference center and early detection of oropharyngeal GAS were important factors for optimal adherence to the prophylactic treatment. Patients with disease progression were associated with noncompliance to secondary prophylaxis. No patients undergoing regular prophylaxis presented progression of the rheumatic cardiac disease. Eighteen valvular surgeries were performed, and four (0.7%) patients died. This study confirmed that tailored and active efforts invested in rheumatic heart disease secondary prevention allowed for significant clinical improvement.
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Affiliation(s)
| | | | - Gabrielle de Crombrugghe
- Division of Pediatric Infectious Diseases and Infection Prevention and Control, Hospital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | | | | | | | - Pierre R Smeesters
- Division of Pediatric Infectious Diseases and Infection Prevention and Control, Hospital Universitaire des Enfants Reine Fabiola, Brussels, Belgium.,Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Molecular Bacteriology Laboratory, Faculty of Medicine, Free University of Brussels, Brussels, Belgium
| | - Rosângela Stadnick Lauth de Almeida Torres
- Department of Medicine, Universidade Positivo, Curitiba, Brazil.,Epidemiology Laboratory and Disease Control Division, Laboratório Central do Estado do Paraná, Curitiba, Brazil
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Kevat PM, Gunnarsson R, Reeves BM, Ruben AR. Adherence rates and risk factors for suboptimal adherence to secondary prophylaxis for rheumatic fever. J Paediatr Child Health 2021; 57:419-424. [PMID: 33340191 PMCID: PMC8048926 DOI: 10.1111/jpc.15239] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/19/2020] [Accepted: 10/06/2020] [Indexed: 11/28/2022]
Abstract
AIM Secondary prophylaxis with 3-4 weekly benzathine penicillin G injections is necessary to prevent disease morbidity and cardiac mortality in patients with acute rheumatic fever (ARF) and rheumatic heart disease (RHD). This study aimed to determine secondary prophylaxis adherence rates in the Far North Queensland paediatric population and to identify factors contributing to suboptimal adherence. METHODS A retrospective analysis of data recorded in the online RHD register for Queensland, Australia, was performed for a 10-year study period. The proportion of benzathine penicillin G injections delivered within intervals of ≤28 days and ≤35 days was measured. A multi-level mixed model logistic regression assessed the influence of age, gender, ethnicity, suburb, Accessibility and Remoteness Index of Australia class, number of people per dwelling, Index of Relative Socio-economic Advantage and Disadvantage, Index of Education and Occupation, year of inclusion on an ARF/RHD register and individual effect. RESULTS The study included 277 children and analysis of 7374 injections. No children received ≥80% of recommended injections within a 28-day interval. Four percent received ≥50% of injections within ≤28 days and 46% received ≥50% of injections at an extended interval of ≤35 days. Increasing age was associated with reduced delivery of injections within 35 days. Increasing year of inclusion was associated with improved delivery within 28 days. The random effect of individual patients was significantly associated with adherence. CONCLUSIONS Improved timely delivery of secondary prophylaxis for ARF and RHD is needed as current adherence is very low. Interventions should focus on factors specific to each individual child or family unit.
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Affiliation(s)
- Priya M Kevat
- College of Medicine and DentistryJames Cook UniversityCairnsQueenslandAustralia
- Clinical ServicesApunipima Cape York Health CouncilCairnsQueenslandAustralia
- Department of PaediatricsCairns and Hinterland Hospital and Health ServiceCairnsQueenslandAustralia
- The Royal Children's HospitalMelbourneVictoriaAustralia
| | - Ronny Gunnarsson
- College of Medicine and DentistryJames Cook UniversityCairnsQueenslandAustralia
- Research, Development, Education and InnovationPrimary Health CareGothenburgRegion Västra GötalandSweden
- General Practice/Family Medicine, Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Benjamin M Reeves
- Department of PaediatricsCairns and Hinterland Hospital and Health ServiceCairnsQueenslandAustralia
| | - Alan R Ruben
- Clinical ServicesApunipima Cape York Health CouncilCairnsQueenslandAustralia
- Medical Services, Torres and Cape Hospital and Health ServiceCairnsQueenslandAustralia
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de Dassel JL, de Klerk N, Carapetis JR, Ralph AP. How Many Doses Make a Difference? An Analysis of Secondary Prevention of Rheumatic Fever and Rheumatic Heart Disease. J Am Heart Assoc 2019; 7:e010223. [PMID: 30561268 PMCID: PMC6405600 DOI: 10.1161/jaha.118.010223] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Acute rheumatic fever ( ARF ) and rheumatic heart disease cause substantial burdens worldwide. Long-term antibiotic secondary prophylaxis is used to prevent disease progression, but evidence for benefits of different adherence levels is limited. Using data from northern Australia, we identified factors associated with adherence, and the association between adherence and ARF recurrence, progression to rheumatic heart disease, worsening or improvement of rheumatic heart disease, and mortality. Methods and Results Factors associated with adherence (percent of doses administered) were analyzed using logistic regression. Nested case-control and case-crossover designs were used to investigate associations with clinical outcomes; conditional logistic regression was used to estimate odds ratios ( OR ) with 95% CIs Adherence estimates (7728) were analyzed. Being female, younger, having more-severe disease, and living remotely were associated with higher adherence. Alcohol misuse was associated with lower adherence. The risk of ARF recurrence did not decrease until ≈40% of doses had been administered. Receiving <80% was associated with a 4-fold increase in the odds of ARF recurrence (case-control OR : 4.00 [95% CI : 1.7-9.29], case-crossover OR : 3.31 [95% CI : 1.09-10.07]) and appeared to be associated with increased all-cause mortality (case-control OR : 1.90 [95% CI : 0.89-4.06]; case-crossover OR 1.91 [95% CI : 0.51-7.12]). Conclusions We show for the first time that increased adherence to penicillin prophylaxis is associated with reduced ARF recurrence, and a likely reduction in mortality, in our setting. These findings can motivate patients to receive doses since even relatively low adherence can be beneficial, and additional doses further reduce adverse clinical outcomes.
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Affiliation(s)
| | - Nick de Klerk
- 3 Telethon Kids Institute University of Western Australia Perth Australia
| | - Jonathan Rhys Carapetis
- 3 Telethon Kids Institute University of Western Australia Perth Australia.,4 Princess Margaret Hospital for Children Perth Australia
| | - Anna P Ralph
- 1 Menzies School of Health Research Charles Darwin University Darwin Australia.,2 Royal Darwin Hospital Darwin Australia
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