1
|
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] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/23/2023] [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.
Collapse
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
| |
Collapse
|
2
|
Owusu IK, Acheamfour-Akowuah E, Wiafe YA. Clinical and Socio-Demographic Profiles of Patients Seen with Rheumatic Heart Disease in a Cardiac Clinic of a Tertiary Hospital in Ghana. RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2022. [DOI: 10.2147/rrcc.s372472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
3
|
Rentta NN, Bennett J, Leung W, Webb R, Jack S, Harwood M, Baker MG, Lund M, Wilson N. Medical Treatment for Rheumatic Heart Disease: A Narrative Review. Heart Lung Circ 2022; 31:1463-1470. [PMID: 35987720 DOI: 10.1016/j.hlc.2022.07.013] [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: 11/25/2021] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are rare in high-income countries; however, in Aotearoa New Zealand ARF and RHD disproportionately affect Indigenous Māori and Pacific Peoples. This narrative review explores the evidence regarding non-surgical management of patients with clinically significant valve disease or heart failure due to RHD. METHODS Medline, EMBASE and Scopus databases were searched, and additional publications were identified through cross-referencing. Included were 28 publications from 1980 onwards. RESULTS Of the available interventions, improved anticoagulation management and a national RHD register could improve RHD outcomes in New Zealand. Where community pharmacy anticoagulant management services (CPAMS) are available good anticoagulation control can be achieved with a time in the therapeutic range (TTR) of more than 70%, which is above the internationally recommended level of 60%. The use of pharmacists in anticoagulation control is cost-effective, acceptable to patients, pharmacists, and primary care practitioners. There is a lack of local data available to fully assess other interventions; including optimal therapy for heart failure, equitable access to specialist RHD care, prevention, and management of endocarditis. CONCLUSION As RHD continues to disproportionately affect Indigenous and minority groups, pro-equity tertiary prevention interventions should be fully evaluated to ensure they are reducing disease burden and improving outcomes in patients with RHD.
Collapse
Affiliation(s)
| | - Julie Bennett
- Department of Public Health, University of Otago, Wellington, New Zealand.
| | - William Leung
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Rachel Webb
- Auckland District Health Board, Auckland, New Zealand; University of Auckland, Department of Paediatrics: Child and Youth Health, Auckland, New Zealand
| | - Susan Jack
- Public Health South, Southern District Health Board, Dunedin, New Zealand
| | - Matire Harwood
- General Practice and Primary Healthcare, University of Auckland, Auckland, New Zealand
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Mayanna Lund
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Nigel Wilson
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand; Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| |
Collapse
|
4
|
Piepoli MF, Adamo M, Barison A, Bestetti RB, Biegus J, Böhm M, Butler J, Carapetis J, Ceconi C, Chioncel O, Coats A, Crespo-Leiro MG, de Simone G, Drexel H, Emdin M, Farmakis D, Halle M, Heymans S, Jaarsma T, Jankowska E, Lainscak M, Lam CSP, Løchen ML, Lopatin Y, Maggioni A, Matrone B, Metra M, Noonan K, Pina I, Prescott E, Rosano G, Seferovic PM, Sliwa K, Stewart S, Uijl A, Vaartjes I, Vermeulen R, Verschuren WM, Volterrani M, Von Haehling S, Hoes A. Preventing heart failure: a position paper of the Heart Failure Association in collaboration with the European Association of Preventive Cardiology. Eur J Prev Cardiol 2022; 29:275-300. [PMID: 35083485 DOI: 10.1093/eurjpc/zwab147] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/15/2021] [Accepted: 08/18/2021] [Indexed: 02/05/2023]
Abstract
The heart failure epidemic is growing and its prevention, in order to reduce associated hospital readmission rates and its clinical and economic burden, is a key issue in modern cardiovascular medicine. The present consensus document aims to provide practical evidence-based information to support the implementation of effective preventive measures. After reviewing the most common risk factors, an overview of the population attributable risks in different continents is presented, to identify potentially effective opportunities for prevention and to inform preventive strategies. Finally, potential interventions that have been proposed and have been shown to be effective in preventing HF are listed.
Collapse
Affiliation(s)
- Massimo F Piepoli
- Cardiac Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Marianna Adamo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Andrea Barison
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Jan Biegus
- Department of Heart Diseases, Medical University, Wroclaw, Poland
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia and Perth Children's Hospital, Perth, Australia
| | - Claudio Ceconi
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Ovidiu Chioncel
- University of Medicine Carol Davila, Bucharest, Romania
- Emergency Institute for Cardiovascular Diseases 'C.C. Iliescu', Bucharest, Romania
| | | | - Maria G Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC): CIBERCV, Universidade da Coruña (UDC), Instituto Ciencias Biomedicas A Coruña (INIBIC), A Coruña, Spain
| | - Giovanni de Simone
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Heinz Drexel
- Department of Medicine, Landeskrankenhaus Bregenz, Bregenz, Austria
- VIVIT, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Martin Halle
- Sport and Health Sciences, Policlinic for Preventive and Rehabilitative Sports Medicine, TUM School of Medicine, Munich, Germany
| | - Stephane Heymans
- Department of Cardiology, Maastricht University, CARIM School for Cardiovascular Diseases, Maastricht, Netherlands
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linköping, Sweden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ewa Jankowska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Natural Sciences and Mathematics, University of Maribor, Maribor, Slovenia
| | - Carolyn S P Lam
- National Heart Centre Singapore, Duke-National University of Singapore, Singapore, Singapore
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Yuri Lopatin
- Volgograd State Medical University, Regional Cardiology Centre, Volgograd, Russian Federation
| | | | | | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Katharine Noonan
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | | | - Eva Prescott
- Bispebjerg Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Petar M Seferovic
- Belgrade University Faculty of Medicine, Serbian Academy of Science and Arts, Belgrade, Serbia
| | - Karen Sliwa
- University of Cape Town, Cape Town, South Africa
| | - Simon Stewart
- Torrens University Australia, Adelaide, South Australia, Australia
| | - Alicia Uijl
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Belgium
- Division of Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Roel Vermeulen
- Division of Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - W M Verschuren
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Stephan Von Haehling
- Department of Cardiology and Pneumology, Heart Center, University of Göttingen Medical Center, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Germany
| | - Arno Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
5
|
Piepoli MF, Adamo M, Barison A, Bestetti RB, Biegus J, Böhm M, Butler J, Carapetis J, Ceconi C, Chioncel O, Coats A, Crespo-Leiro MG, de Simone G, Drexel H, Emdin M, Farmakis D, Halle M, Heymans S, Jaarsma T, Jankowska E, Lainscak M, Lam CSP, Løchen ML, Lopatin Y, Maggioni A, Matrone B, Metra M, Noonan K, Pina I, Prescott E, Rosano G, Seferovic PM, Sliwa K, Stewart S, Uijl A, Vaartjes I, Vermeulen R, Monique Verschuren WM, Volterrani M, von Heahling S, Hoes A. Preventing heart failure: a position paper of the Heart Failure Association in collaboration with the European Association of Preventive Cardiology. Eur J Heart Fail 2022; 24:143-168. [PMID: 35083829 DOI: 10.1002/ejhf.2351] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/15/2021] [Accepted: 08/18/2021] [Indexed: 12/16/2022] Open
Abstract
The heart failure epidemic is growing and its prevention, in order to reduce associated hospital readmission rates and its clinical and economic burden, is a key issue in modern cardiovascular medicine. The present position paper aims to provide practical evidence-based information to support the implementation of effective preventive measures. After reviewing the most common risk factors, an overview of the population attributable risks in different continents is presented, to identify potentially effective opportunities for prevention and to inform preventive strategies. Finally, potential interventions that have been proposed and have been shown to be effective in preventing heart failure are listed.
Collapse
Affiliation(s)
- Massimo F Piepoli
- Cardiac Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Marianna Adamo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Andrea Barison
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Jan Biegus
- Department of Heart Diseases, Medical University, Wroclaw, Poland
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia and Perth Children's Hospital, Perth, Australia
| | - Claudio Ceconi
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Ovidiu Chioncel
- University of Medicine Carol Davila, Bucharest, Romania
- Emergency Institute for Cardiovascular Diseases 'C.C. Iliescu', Bucharest, Romania
| | | | - Maria G Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC): CIBERCV, Universidade da Coruña (UDC), Instituto Ciencias Biomedicas A Coruña (INIBIC), A Coruña, Spain
| | - Giovanni de Simone
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Heinz Drexel
- Department of Medicine, Landeskrankenhaus Bregenz, Bregenz, Austria
- VIVIT, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Martin Halle
- Sport and Health Sciences, Policlinic for Preventive and Rehabilitative Sports Medicine, TUM School of Medicine, Munich, Germany
| | - Stephane Heymans
- Department of Cardiology, Maastricht University, CARIM School for Cardiovascular Diseases, Maastricht, the Netherlands
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linköping, Sweden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ewa Jankowska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Natural Sciences and Mathematics, University of Maribor, Maribor, Slovenia
| | - Carolyn S P Lam
- National Heart Centre Singapore, Duke-National University of Singapore, Singapore, Singapore
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Yuri Lopatin
- Volgograd State Medical University, Regional Cardiology Centre, Volgograd, Russian Federation
| | | | | | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Katharine Noonan
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | | | - Eva Prescott
- Bispebjerg Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Petar M Seferovic
- Belgrade University Faculty of Medicine, Serbian Academy of Science and Arts, Belgrade, Serbia
| | - Karen Sliwa
- University of Cape Town, Cape Town, South Africa
| | - Simon Stewart
- Torrens University Australia, Adelaide, South Australia, Australia
| | - Alicia Uijl
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Belgium
- Division of Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Roel Vermeulen
- Division of Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - W M Monique Verschuren
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | | | - Stephan von Heahling
- Department of Cardiology and Pneumology, Heart Center, University of Göttingen Medical Center, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Germany
| | - Arno Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
6
|
Rheumatic heart disease in The Gambia: clinical and valvular aspects at presentation and evolution under penicillin prophylaxis. BMC Cardiovasc Disord 2021; 21:503. [PMID: 34663206 PMCID: PMC8525010 DOI: 10.1186/s12872-021-02308-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) remains the leading cause of cardiac-related deaths and disability in children and young adults worldwide. In The Gambia, the RHD burden is thought to be high although no data are available and no control programme is yet implemented. We conducted a pilot study to generate baseline data on the clinical and valvular characteristics of RHD patients at first presentation, adherence to penicillin prophylaxis and the evolution of lesions over time. METHODS All patients registered with acute rheumatic fever (ARF) or RHD at two Gambian referral hospitals were invited for a clinical review that included echocardiography. In addition, patients were interviewed about potential risk factors, disease history, and treatment adherence. All clinical and echocardiography information at first presentation and during follow-up was retrieved from medical records. RESULTS Among 255 registered RHD patients, 35 had died, 127 were examined, and 111 confirmed RHD patients were enrolled, 64% of them females. The case fatality rate in 2017 was estimated at 19.6%. At first presentation, median age was 13 years (IQR [9; 18]), 57% patients had late stage heart failure, and 84.1% a pathological heart murmur. Although 53.2% of them reported history of recurrent sore throat, only 32.2% of them had sought medical treatment. A history suggestive of ARF was reported by 48.7% patients out of whom only 15.8% were adequately treated. Two third of the patients (65.5%) to whom it was prescribed were fully adherent to penicillin prophylaxis. Progressive worsening and repeated hospitalisation was experienced by 46.8% of the patients. 17 patients had cardiac surgery, but they represented only 18.1% of the 94 patients estimated eligible for cardiac surgery. CONCLUSION This study highlights for the first time in The Gambia the devastating consequences of RHD on the health of adolescents and young adults. Our findings suggest a high burden of disease that remains largely undetected and without appropriate secondary prophylaxis. There is a need for the urgent implementation of an effective national RHD control programto decrease the unacceptably high mortality rate, improve case detection and management, and increase community awareness of this disease.
Collapse
|
7
|
Davis K, de Oliveira LN, da Silva Almeida I, Noronha M, Martins J, Dos Santos M, Monteiro A, Brewster D, Horton A, Remenyi B, Francis JR. Morbidity and mortality of rheumatic heart disease and acute rheumatic fever in the inpatient setting in Timor-Leste. J Paediatr Child Health 2021; 57:1391-1396. [PMID: 33825269 DOI: 10.1111/jpc.15476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/25/2021] [Indexed: 11/29/2022]
Abstract
AIM To describe the clinical features, treatment and outcomes of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in children admitted to the national referral hospital in Dili, Timor-Leste. METHODS This prospective study documented cases of ARF and RHD in children aged 14 years and under who were admitted between June 2017 and May 2019. ARF was diagnosed using an adapted version of the 2015 Jones criteria and presumed (rather than proven) exposure to group A Streptococcus. Clinical and echocardiographic findings, comorbidities and discharge outcomes are reported. RESULTS A total of 63 patients were admitted with ARF or RHD; 54 were diagnosed with RHD for the first time. Median age was 11 years (range 3-14); 48% were female. Of those with echocardiograms, 56/58 had RHD, 55/56 (98%) had mitral regurgitation (37/55 (67%) severe), 11/56 (20%) had mitral stenosis and 43/56 (77%) had aortic regurgitation. Left ventricular dysfunction (55%), pulmonary hypertension (64%) and cardiac failure (78%) were common. Four (6%) patients died in hospital, and 30/59 (51%) of surviving patients were lost to follow up. CONCLUSIONS Community echocardiography screening has reported a high prevalence of undetected mild to moderate cases of RHD in Timor-Leste, whereas this hospital study documents mostly severe disease among hospitalised patients with a high case fatality rate and loss to follow up. RHD is a significant health problem in Timor-Leste and improved recognition and diagnosis, as well as effective delivery of treatment and follow-up are imperative.
Collapse
Affiliation(s)
- Kimberly Davis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | | | | | - Mario Noronha
- Department of Paediatrics, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Joao Martins
- Department of Paediatrics, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Milena Dos Santos
- Department of Paediatrics, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Andre Monteiro
- Department of Paediatrics, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - David Brewster
- Department of Paediatrics, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Ari Horton
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,East Timor Hearts Fund, Melbourne, Victoria, Australia
| | - Bo Remenyi
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Joshua R Francis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| |
Collapse
|
8
|
Marijon E, Mocumbi A, Narayanan K, Jouven X, Celermajer DS. Persisting burden and challenges of rheumatic heart disease. Eur Heart J 2021; 42:3338-3348. [PMID: 34263296 DOI: 10.1093/eurheartj/ehab407] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/02/2021] [Accepted: 06/13/2021] [Indexed: 11/13/2022] Open
Abstract
Rheumatic heart disease (RHD) is the result of episodes of acute rheumatic fever with valvular (and other cardiac) damage caused by an abnormal immune response to group A streptococcal infections, usually during childhood and adolescence. As a result of improved living conditions and the introduction of penicillin, RHD was almost eradicated in the developed world by the 1980s. However, being a disease of poverty, its burden remains disproportionately high in the developing world, despite being a fundamentally preventable disease. Rheumatic heart disease generates relatively little attention from the medical and science communities, in contrast to other common infectious problems (such as malaria, HIV, tuberculosis), despite the major cardiovascular morbidity/mortality burden imposed by RHD. This relative neglect and paucity of funding have probably contributed to limited fundamental medical advances in this field for over 50 years. Given the importance of prevention before the onset of major valvular damage, the main challenges for RHD prevention are improving social circumstances, early diagnosis, and effective delivery of antibiotic prophylaxis. Early identification through ultrasound of silent, subclinical rheumatic valve lesions could provide an opportunity for early intervention. Simple echocardiographic diagnostic criteria and appropriately trained personnel can be valuable aids in large-scale public health efforts. In addition, a better understanding of the immunogenic determinants of the disease may provide potential routes to vaccine development and other novel therapies.
Collapse
Affiliation(s)
- Eloi Marijon
- University of Paris, PARCC, INSERM, Global Health Unit, Paris F-75015, France.,Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Ana Mocumbi
- Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique.,Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Kumar Narayanan
- University of Paris, PARCC, INSERM, Global Health Unit, Paris F-75015, France.,Medicover Hospitals, Hyderabad, India
| | - Xavier Jouven
- University of Paris, PARCC, INSERM, Global Health Unit, Paris F-75015, France.,Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - David S Celermajer
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
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
|
11
|
Mulugeta T, Kumela K, Chelkeba L. <p>Clinical, Echocardiographic Characteristics and Management Practices in Patients with Rheumatic Valvular Heart Disease</p>. Open Access Rheumatol 2020; 12:233-239. [PMID: 33116969 PMCID: PMC7548315 DOI: 10.2147/oarrr.s274519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/24/2020] [Indexed: 11/23/2022] Open
Abstract
Background Rheumatic heart disease (RHD) is the long-term consequence of acute rheumatic fever (ARF), continues unabated among middle-income and low-income countries. Thus, this study aimed to assess clinical characteristics, echocardiographic characteristics, and management practice of RHD patients. Methods Hospital-based prospective cross-sectional study was used. The data were collected from medical records of consecutive patients admitted to medical wards during the study period. The data were cleaned and analyzed using SPSS version 20. Descriptive statistics were used to describe the data. Chi-square was used to compare proportions between categorical variables. Results Forty-seven patients with a median (IQR) age of 28.0 (17.0-40.0) years were included. Pan systolic murmur was reported in 91.50% of patients. Forty-two (89.4%) of patients were presented with congestive heart failure and 23 (48.9%) with atrial fibrillation. Mitral valve leaflet thickening and calcification with restriction of motion were reported in 91.5% of patients. Mitral regurgitation (MR) (87.2%) and stenosis (MS) (85.1%) were the most common valvular lesions. The combinations of three (MR+MS+TR) 14 (29.8%) and four (MR+MS+TR+AR) 13 (27.7%) valve diseases were most commonly reported. Diuretics (95.7%), anticoagulants (38.3%), digoxin (36.2%), and beta-blockers (34.0%) were among the commonly prescribed medications. Conclusion Rheumatic heart disease affected younger adults. Pansystolic murmur was reported in nearly all patients. Congestive heart failure and atrial fibrillation were common clinical presentations. Morphologic changes in mitral valve and pathologic mitral regurgitation were the most common echocardiographic reports. Cardiovascular medications were commonly utilized for symptomatic management of complications Therefore, echocardiography should be done routinely for patients with RHD, focusing on younger adults, to facilitate diagnosis and treatment before complications develop.
Collapse
Affiliation(s)
- Temesgen Mulugeta
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
- Correspondence: Temesgen MulugetaDepartment of Clinical Pharmacy, Institute of Health, Jimma University, P. O Box: 378, Jimma, Oromia, EthiopiaTel +251 917734764 Email
| | - Kabaye Kumela
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Legese Chelkeba
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| |
Collapse
|
12
|
Burleson SL, Pigott DC, Gullett JP, Greene C, Gibson CB, Irvine S, Kaminstein D. Point-of-care ultrasound in resource-limited settings: the PURLS fellowship. Ultrasound J 2020; 12:14. [PMID: 32193724 PMCID: PMC7082434 DOI: 10.1186/s13089-020-00159-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/06/2020] [Indexed: 01/21/2023] Open
Abstract
Background The role of point-of-care ultrasonography (POCUS) is rapidly expanding in both resource-rich and resource-limited settings (RLS). One limitation to this rapid expansion has been the lack of educators adequately trained to teach this user-dependent skill. This is particularly true in RLS, where disease presentations, infrastructure limitations, and approach to medical education present unique challenges to the direct application of resource-rich emergency department POCUS curricula. Objectives We describe the point-of-care ultrasound in resource-limited settings (PURLS) fellowship, a novel curriculum designed to provide advanced training and expertise in clinical care and POCUS application and education in RLS. Conclusion Our curriculum design is one approach to create context-specific POCUS education for use in RLS, thereby improving patient care.
Collapse
Affiliation(s)
- Samuel L Burleson
- Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Old Hillman Building Suite 251, 619 19th St S, Birmingham, AL, 35249, USA.
| | - David C Pigott
- Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Old Hillman Building Suite 251, 619 19th St S, Birmingham, AL, 35249, USA
| | - John P Gullett
- Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Old Hillman Building Suite 251, 619 19th St S, Birmingham, AL, 35249, USA
| | - Christopher Greene
- Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Old Hillman Building Suite 251, 619 19th St S, Birmingham, AL, 35249, USA
| | - Courtney B Gibson
- Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Old Hillman Building Suite 251, 619 19th St S, Birmingham, AL, 35249, USA
| | - Scott Irvine
- Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Old Hillman Building Suite 251, 619 19th St S, Birmingham, AL, 35249, USA
| | - Daniel Kaminstein
- Department of Emergency Medicine, Augusta University, Augusta, GA, USA
| |
Collapse
|
13
|
Vaughan G, Dawson A, Peek MJ, Carapetis JR, Sullivan EA. Standardizing clinical care measures of rheumatic heart disease in pregnancy: A qualitative synthesis. Birth 2019; 46:560-573. [PMID: 31150150 DOI: 10.1111/birt.12435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Rheumatic heart disease (RHD) is a preventable cardiac condition that escalates risk in pregnancy. Models of care informed by evidence-based clinical guidelines are essential to optimal health outcomes. There are no published reviews that systematically explore approaches to care provision for pregnant women with RHD and examine reported measures. The review objective was to improve understanding of how attributes of care for these women are reported and how they align with guidelines. METHODS A search of 13 databases was supported by hand-searching. Papers that met inclusion criteria were appraised using CASP/JBI checklists. A content analysis of extracted data from the findings sections of included papers was undertaken, informed by attributes of quality care identified previously from existing guidelines. RESULTS The 43 included studies were predominantly conducted in tertiary care centers of low-income and middle-income countries. Cardiac guidelines were referred to in 25 of 43 studies. Poorer outcomes were associated with higher risk scores (detailed in 36 of 41 quantitative studies). Indicators associated with increased risk include anticoagulation during pregnancy (28 of 41 reported) and late booking (gestation documented in 15 of 41 studies). Limited access to cardiac interventions was discussed (19 of 43) in the context of poorer outcomes. Conversely, early assessment and access to regular multidisciplinary care were emphasized in promoting optimal outcomes for women and their babies. CONCLUSIONS Despite often complex care requirements in challenging environments, pregnancy provides an opportunity to strengthen health system responses and address whole-of-life health for women with RHD. A standard set of core indicators is proposed to more accurately benchmark care pathways, outcomes, and burden.
Collapse
Affiliation(s)
- Geraldine Vaughan
- Faculty of Health, Australian Centre for Public and Population Health Research (ACPPHR), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Angela Dawson
- Faculty of Health, Australian Centre for Public and Population Health Research (ACPPHR), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Michael J Peek
- The Australian National University and Centenary Hospital for Women and Children, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Jonathan R Carapetis
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Elizabeth A Sullivan
- Faculty of Health, Australian Centre for Public and Population Health Research (ACPPHR), University of Technology Sydney, Sydney, New South Wales, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| |
Collapse
|
14
|
Dhar M, Kaeley N, Bhatt N, Ahmad S. Profile of newly diagnosed adult patients with rheumatic heart disease in sub-Himalayan region - A 5-year analysis. J Family Med Prim Care 2019; 8:2933-2936. [PMID: 31681670 PMCID: PMC6820389 DOI: 10.4103/jfmpc.jfmpc_363_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/25/2019] [Accepted: 07/12/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction: Rheumatic heart disease (RHD) is one of the leading acquired causes of cardiac diseases affecting the young population, worldwide. Aims and Objectives: The primary objective was to study the prevalence, profile, and complications of patients with RHD in a tertiary care hospital of Uttarakhand. The secondary objective was to assess the demographic and clinical parameters of patients with RHDs. Materials and Methods: All adult patients above the age of 18 years, diagnosed with RHD, over a period of 5 years from July 2008 to June 2013 were enrolled in the study. Detailed clinical data of the patients were obtained retrospectively from the hospital record section. Information regarding prevalence of RHD, profile, and complications of patients with RHD was collected from patient's case sheet and tabulated. Results: In all, 1001 patients age more than 18 years with RHD presented to either medical or cardiology outpatient departments over a period of 5 years from July 11 to June 2018. Mitral regurgitation (n = 610, 61.9%) was the most common RHD. Females (n = 538, 53%) outnumbered males (n = 464, 46.2%). Heart failure (n = 353, 35.1%), severe pulmonary arterial hypertension (n = 118, 11.7%), and atrial fibrillation (n = 212, 21.1%) were common complications. A total of 75 (7.4%) patients presented with bacterial endocarditis, whereas 32 (3.2%) patients succumbed to death due to RHD.
Collapse
Affiliation(s)
- Minakshi Dhar
- Department of General Medicine, AIIMS, Rishkesh, Uttarakhand, India
| | - Nidhi Kaeley
- Department of Emergency Medicine, AIIMS, Rishkesh, Uttarakhand, India
| | - Nowneet Bhatt
- Department of Paediatrics, AIIMS Rishkesh, Uttarakhand, India
| | - Sohaib Ahmad
- Department of General Medicine, HIHT, Jolly Grant, Dehradun, Uttarakhand, India
| |
Collapse
|
15
|
Horwood PF, Tarantola A, Goarant C, Matsui M, Klement E, Umezaki M, Navarro S, Greenhill AR. Health Challenges of the Pacific Region: Insights From History, Geography, Social Determinants, Genetics, and the Microbiome. Front Immunol 2019; 10:2184. [PMID: 31572391 PMCID: PMC6753857 DOI: 10.3389/fimmu.2019.02184] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/29/2019] [Indexed: 02/06/2023] Open
Abstract
The Pacific region, also referred to as Oceania, is a geographically widespread region populated by people of diverse cultures and ethnicities. Indigenous people in the region (Melanesians, Polynesians, Micronesians, Papuans, and Indigenous Australians) are over-represented on national, regional, and global scales for the burden of infectious and non-communicable diseases. Although social and environmental factors such as poverty, education, and access to health-care are assumed to be major drivers of this disease burden, there is also developing evidence that genetic and microbiotic factors should also be considered. To date, studies investigating genetic and/or microbiotic links with vulnerabilities to infectious and non-communicable diseases have mostly focused on populations in Europe, Asia, and USA, with uncertain associations for other populations such as indigenous communities in Oceania. Recent developments in personalized medicine have shown that identifying ethnicity-linked genetic vulnerabilities can be important for medical management. Although our understanding of the impacts of the gut microbiome on health is still in the early stages, it is likely that equivalent vulnerabilities will also be identified through the interaction between gut microbiome composition and function with pathogens and the host immune system. As rapid economic, dietary, and cultural changes occur throughout Oceania it becomes increasingly important that further research is conducted within indigenous populations to address the double burden of high rates of infectious diseases and rapidly rising non-communicable diseases so that comprehensive development goals can be planned. In this article, we review the current knowledge on the impact of nutrition, genetics, and the gut microbiome on infectious diseases in indigenous people of the Pacific region.
Collapse
Affiliation(s)
- Paul F. Horwood
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | | | - Cyrille Goarant
- Institut Pasteur de Nouvelle-Calédonie, Noumea, New Caledonia
| | - Mariko Matsui
- Institut Pasteur de Nouvelle-Calédonie, Noumea, New Caledonia
| | - Elise Klement
- Institut Pasteur de Nouvelle-Calédonie, Noumea, New Caledonia
- Internal Medicine and Infectious Diseases Department, Centre Hospitalier Territorial, Noumea, New Caledonia
| | - Masahiro Umezaki
- Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Severine Navarro
- Immunology Department, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Andrew R. Greenhill
- School of Health and Life Sciences, Federation University Australia, Churchill, VIC, Australia
| |
Collapse
|
16
|
Negi PC, Sondhi S, Rana V, Rathoure S, Kumar R, Kolte N, Kumar R, Rao S, Diman A, Mahajan K, Dev M, Kandoria A, Ganju N, Bhardwaj R, Merwaha R, Sharma R, Asotra S. Prevalence, risk determinants and consequences of atrial fibrillation in rheumatic heart disease: 6 years hospital based-Himachal Pradesh- Rheumatic Fever/Rheumatic Heart Disease (HP-RF/RHD) Registry. Indian Heart J 2018; 70 Suppl 3:S68-S73. [PMID: 30595324 PMCID: PMC6309149 DOI: 10.1016/j.ihj.2018.05.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/27/2018] [Accepted: 05/11/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To report the prevalence, risk factors and consequences of atrial fibrillation (AF) in patients of rheumatic heart disease (RHD). METHODS The Himachal Pradesh- Rheumatic Fever/Rheumatic Heart Disease (HP-RF/RHD) Registry database of 1918 patients was analyzed. AF was diagnosed with 12-lead ECG recording at entry in to the registry. The association of AF with nature and severity of valvular dysfunction was analyzed, adjusted for age, left atrial (LA) dimension and pulmonary arterial hypertension using multivariable logistic regression model and strength of association was reported as odds ratio (OR) with 95% confidence intervals (C. I.). RESULTS The study population consisted of young (40.2 ± 14.3 years), predominantly females (72.3%) from rural area (94.1%). Prevalence of AF was 23.9% (95% C. I. 22.1%-25.8%). The independent determinants AF were age (OR 1.04, 95% C.I. 1.03-1.06), LA size (OR 1.10, 95% C.I. 1.08-1.11). The association of AF with age, New York Heart Association functional class, mitral stenosis severity and tricuspid regurgitation was statistically significant and graded. Mitral regurgitation and aortic valve disease had no significant independent association with AF. The prevalence of heart failure, stroke, peripheral embolism and mortality was significantly higher among patients with AF (p < .01). CONCLUSION AF is common in RHD patients and is significantly associated with heart failure and systemic thromboembolism. Age, mitral stenosis severity, tricuspid regurgitation and LA size were independently associated with AF.
Collapse
|
17
|
Negi PC, Mahajan K, Rana V, Sondhi S, Mahajan N, Rathour S, Verma R, Dhiman A, Dev M, Rao S, Asotra S, Bhardwaj R, Ganju N, Kandoria A, Merwaha R, Sharma R, Kolte N, Kumar V R, Paul PK, Singh DP. Clinical Characteristics, Complications, and Treatment Practices in Patients With RHD: 6-Year Results From HP-RHD Registry. Glob Heart 2018; 13:267-274.e2. [PMID: 30197242 DOI: 10.1016/j.gheart.2018.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 05/28/2018] [Accepted: 06/18/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite the high prevalence of rheumatic heart disease (RHD) in developing countries such as India, data on characteristics, complications, and treatment practices are lacking. The HP-RHD (Himachal Pradesh Rheumatic Heart Disease) registry aimed at reporting these parameters in patients with RHD from a northern state of India. METHODS A total of 2,005 consecutive patients of RHD were enrolled over a period of 6 years (2011 to 2016) in the present study. The clinical characteristics, complications, and treatment practices were systematically recorded. RESULTS The mean age for patients with RHD was 40.3 ± 14.3 (range 5 to 83 years). RHD predominantly affected females (72.3%) and population from rural background (92%). Multivalvular involvement was frequent (43.2%), mitral valve was the commonest affected valve (83.3%). The majority of the patients had moderate-to-severe valvular dysfunction (69.3%). Mitral and tricuspid valve involvement was more frequent in female subjects compared with more frequent aortic valve involvement in male subjects (p < 0.001). The major adverse cardiovascular events were recorded in 23.4% patients at the time of registry and comprised mainly advanced heart failure (15.6%), peripheral embolism (4.1%), and stroke (3.9%). The independent risk determinants of major adverse cardiovascular events (were advanced age (odds ratio [OR]: 1.01; 95% confidence interval [CI]: 1.00-1.02), severe mitral stenosis (OR: 1.73; 95% CI: 1.34-2.20), severe tricuspid regurgitation (OR: 2.11; 95% CI: 1.48-3.02), presence of pulmonary artery hypertension (OR: 1.33; 95% CI: 1.04-1.69), and atrial fibrillation (OR: 1.64; 95% CI: 1.28-2.11). Evidence-based use of oral anticoagulant therapy was documented in 77.7% of high-risk patients. Only 28.5% of study population was receiving secondary prophylaxis. CONCLUSIONS Complications in patients with RHD increase with age and worsening valvular dysfunction. Programs focused on early detection and evidence-based management will assist in improving outcomes.
Collapse
Affiliation(s)
- Prakash Chand Negi
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Kunal Mahajan
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
| | - Vivek Rana
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Sachin Sondhi
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Nitin Mahajan
- Department of Pediatrics, Washington University in St. Louis, MO, USA
| | - Sanjay Rathour
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Ritesh Verma
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Ashish Dhiman
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Munish Dev
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Shivani Rao
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Sanjeev Asotra
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Rajeev Bhardwaj
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Neeraj Ganju
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Arvind Kandoria
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Rajeev Merwaha
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Rajesh Sharma
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Nirmal Kolte
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Ravi Kumar V
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Prince Kumar Paul
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Davinder Pal Singh
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| |
Collapse
|
18
|
Abstract
Rheumatic heart disease (RHD) is a chronic valvular disease resulting after severe or repetitive episodes of acute rheumatic fever (ARF), an autoimmune response to group A Streptococcus infection. RHD has been almost eliminated with improved social and health infrastructure in affluent countries while it remains a neglected disease with major cause of morbidity and mortality in many low- and middle-income countries, and resource-limited regions of high-income countries. Despite our evolving understanding of the pathogenesis of RHD, there have not been any significant advances to prevent or halt progression of disease in recent history. Long-term penicillin-based treatment and surgery remain the backbone of a RHD control program in the absence of an effective vaccine. The advent of echocardiographic screening algorithms has improved the accuracy of diagnosing RHD and has shed light on the enormous burden of disease. Encouragingly, this has led to a rekindled commitment from researchers in the most affected countries to advocate and take bold actions to end this disease of social inequality.
Collapse
Affiliation(s)
- Bethel Woldu
- Vanderbilt Institute for Global Health, Vanderbilt University, 2525 West End Avenue, Suite 750, Nashville, TN, 37203, USA
| | - Gerald S Bloomfield
- Duke Clinical Research Institute, Duke University, 2400 Pratt Street, Durham, NC, 27705, USA.
| |
Collapse
|
19
|
Clinical outcomes for young people with screening-detected and clinically-diagnosed rheumatic heart disease in Fiji. Int J Cardiol 2017; 240:422-427. [DOI: 10.1016/j.ijcard.2017.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 11/18/2022]
|
20
|
Bertaina G, Rouchon B, Huon B, Guillot N, Robillard C, Noël B, Nadra M, Tribouilloy C, Marijon E, Jouven X, Mirabel M. Outcomes of borderline rheumatic heart disease: A prospective cohort study. Int J Cardiol 2017; 228:661-665. [DOI: 10.1016/j.ijcard.2016.11.234] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 11/07/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
|
21
|
Mirabel M, Tafflet M, Noël B, Parks T, Braunstein C, Rouchon B, Marijon E, Jouven X. Prevalence of Rheumatic Heart Disease in the Pacific. J Am Coll Cardiol 2016; 67:1500-1502. [DOI: 10.1016/j.jacc.2016.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 12/31/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
|
22
|
Bacquelin R, Tafflet M, Rouchon B, Guillot N, Marijon E, Jouven X, Mirabel M. Echocardiography-based screening for rheumatic heart disease : What does borderline mean? Int J Cardiol 2016; 203:1003-4. [DOI: 10.1016/j.ijcard.2015.11.110] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/16/2015] [Indexed: 12/01/2022]
|