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Hibino M, Halkos ME, Murphy DA, Dhingra NK, Verma R, Hibino H, Aune D, Yanagawa B, Bhatt DL, Verma S. Age period cohort analysis of rheumatic heart disease in high-income countries. Clin Res Cardiol 2023; 112:1568-1576. [PMID: 36820872 DOI: 10.1007/s00392-023-02168-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Rheumatic heart disease is considered well-controlled in high-income countries; however, its actual trends in mortality remain unclarified. We analyzed trends in mortality from rheumatic heart disease in association with age, period, and birth cohort. METHODS We analyzed the WHO mortality database to determine trends in mortality from rheumatic heart disease in the UK, Germany, France, Italy, Japan, Australia, USA, and Canada from 2000 to 2020. We used age-cohort-period modeling to estimate cohort and period effects. Net drift (overall annual percentage change), local drift (annual percentage change in each age group) and heterogeneity were calculated. RESULTS In the most recent year, crude mortality rates and age-standardized mortality rates ranged from 1.10 in the USA to 6.17 in Germany, and 0.32 (95% CI 0.31-0.34) in Japan and 1.70 (95% CI 1.65-1.75) in Germany, respectively. During the observation period, while Germany had a constant trend in overall annual percentage change, all the other countries had significant decreasing trends (p < 0.0001, respectively). Annual percent change was not homogeneous across each group in all 8 countries (pheterogeneity < 0.0001), with 2 peaks in the younger and older age categories. In Germany, Italy, Australia, and Canada, we found increasing mortality rates among older patients. Improving period and cohort risks for rheumatic heart disease mortality were generally observed, excluding Germany where the period effect was worsening and the cohort effect was constant. CONCLUSIONS Mortality trends from rheumatic heart disease were decreasing in the study high-income countries except for Germany where higher mortality and two peaks in annual percentage change in younger and older age groups warrant further investigation.
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Affiliation(s)
- Makoto Hibino
- Division of Cardiothoracic Surgery, Emory University School of Medicine, 1365 Clifton Rd., Suite A2202, Atlanta, GA, 30322, USA.
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, 8th Floor, Bond Wing, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
| | - Michael E Halkos
- Division of Cardiothoracic Surgery, Emory University School of Medicine, 1365 Clifton Rd., Suite A2202, Atlanta, GA, 30322, USA
| | - Douglas A Murphy
- Division of Cardiothoracic Surgery, Emory University School of Medicine, 1365 Clifton Rd., Suite A2202, Atlanta, GA, 30322, USA
| | - Nitish K Dhingra
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, 8th Floor, Bond Wing, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Raj Verma
- Royal College of Surgeon in Ireland, Dublin, Ireland
| | - Hiromi Hibino
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Bjørknes University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, 8th Floor, Bond Wing, 30 Bond St, Toronto, ON, M5B 1W8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, 8th Floor, Bond Wing, 30 Bond St, Toronto, ON, M5B 1W8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
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Yu G, Gong X, Xu Y, Sun H, Liu Y, Zhai C, Hu W, Zong Q, Hu D, Yan Z, Wang Y, Wang L, Zhang T, Wang F, Zou Y. The global burden and trends of four major types of heart disease, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Public Health 2023; 220:1-9. [PMID: 37182373 DOI: 10.1016/j.puhe.2023.04.005] [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: 12/15/2022] [Revised: 03/28/2023] [Accepted: 04/02/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVES The global burden of heart disease is severe and increasing in the coming years. This study aims to analyze the global burden of heart disease. STUDY DESIGN Rheumatic heart disease (RHD), ischemic heart disease (IHD), hypertensive heart disease (HHD), and non-rheumatic valvular heart disease (NRVHD) were selected and analyzed from the Global Burden of Disease Study 2019. METHODS The prevalence, deaths, disability-adjusted life years and their corresponding age-standardized rates were obtained from the Global Burden of Disease Study 2019. In addition, estimated annual percentage change was calculated to better assess epidemiological trends. In addition, we performed an age-period-cohort analysis using the Nordpred package in R program to predict death trends over the next 20 years. RESULTS Globally, the prevalence of four heart diseases (RHD, IHD, HHD, and NRVHD) increased by 70.5%, 103.5%, 137.9%, and 110.0% compared with 1990, respectively. The deaths cases of RHD decreased by 15.6%, whereas IHD, HHD, and NRVHD increased by 60.4%, 76.6%, and 110.6%. Compared with absolute values, their corresponding age-standardized rates only showed a slight increase trend or even decreased in some areas with high sociodemographic index. In the next 20 years, the absolute values of deaths will continue to increase, whereas their age-standardized rates of deaths will flatten out. CONCLUSIONS Globally, the absolute values of heart disease have increased over the past 30 years and will continue to increase over the next 20 years. Targeted prevention and control strategies and measures need to be developed and improved to reduce this burden.
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Affiliation(s)
- Guanghui Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Xingyu Gong
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Ying Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Hongyu Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yuqi Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Chunxia Zhai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Wanqin Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Qiqun Zong
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Dingtao Hu
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Clinical Cancer Institute, Center for Translational Medicine, Naval Medical University, Shanghai, China
| | - Ziye Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yuhua Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Linlin Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Tingyu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Fang Wang
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yanfeng Zou
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
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Chen WH, Tan Y, Wang YL, Wang X, Liu ZH. Rheumatic valvular heart disease treated with traditional Chinese medicine: A case report. World J Clin Cases 2023; 11:1600-1606. [PMID: 36926399 PMCID: PMC10011998 DOI: 10.12998/wjcc.v11.i7.1600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/19/2023] [Accepted: 02/13/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) is an autoimmune disease that leads to irreversible valve damage and heart failure. Surgery is an effective treatment; however, it is invasive and carries risks, restricting its broad application. Therefore, it is essential to find alternative nonsurgical treatments for RHD.
CASE SUMMARY A 57-year-old woman was assessed with cardiac color Doppler ultrasound, left heart function tests, and tissue Doppler imaging evaluation at Zhongshan Hospital of Fudan University. The results showed mild mitral valve stenosis with mild to moderate mitral and aortic regurgitation, confirming a diagnosis of rheumatic valve disease. After her symptoms became severe, with frequent ventricular tachycardia and supraventricular tachycardia > 200 beats per minute, her physicians recommended surgery. During a 10-day preoperative waiting period, the patient asked to be treated with traditional Chinese medicine. After 1 week of this treatment, her symptoms improved significantly, including resolution of the ventricular tachycardia, and the surgery was postponed pending further follow-up. At 3 -month follow-up, color Doppler ultrasound showed mild mitral valve stenosis with mild mitral and aortic regurgitation. Therefore, it was determined that no surgical treatment was required.
CONCLUSION Traditional Chinese medicine treatment effectively relieves symptoms of RHD, particularly mitral valve stenosis and mitral and aortic regurgitation.
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Affiliation(s)
- Wei-Hang Chen
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing 102488, China
| | - Yan Tan
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing 102488, China
| | - Ya-Lei Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 102488, China
| | - Xu Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 102488, China
| | - Zhao-Heng Liu
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing 102488, China
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Pathak S, Yadav R. Closed Mitral Valvotomy Reenvision. Cureus 2022; 14:e27401. [PMID: 36046295 PMCID: PMC9419540 DOI: 10.7759/cureus.27401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/05/2022] Open
Abstract
In developing countries, like the Indian subcontinent, population overload, malnutrition, poor socio-economic status of affected groups, and health care facilities affect the treatment outcome. Nowadays procedures such as percutaneous balloon mitral valvotomy (PBMV) and open heart mitral valve replacement are offered to patients with mitral stenosis. Whenever PBMV is unavailable due to financial constraints and open surgical management cannot be offered due to overburdened healthcare facilities, closed mitral valvotomy (CMV) provides an excellent choice for patients with favorable mitral valve pathology. Many centers do not practice CMV and thus this procedure is dying out. The young generation of surgeons are not been trained in CMV. The purpose of our study is to reenvision CMV and emphasize its vital role in mitral stenosis patient subsets like pregnant women and young adults. We reviewed the literature for various valvotomy techniques done for mitral valve stenosis and restenosis. Immediate and late outcomes were compared between the patients receiving Percutaneous balloon mitral valvotomy and closed mitral valvotomy. The immediate and late-term results are comparable for PBMV and CMV and no statistically significant difference exists. The post-PBMV Mitral valve area (MVA) ranged from 2.1 +/- 0.7 cm^2 to 2.3 +/-0.94 cm^2 and post CMV MVA ranged from 1.3+/-0.3 cm^2 to 2.2+/-0.85 cm^2. Complications developing in both techniques are also nearly similar. Operative mortality in CMV patients ranged from 1% to 4.2%, also observed in PBMV patients in various studies. Mitral Regurgitation occurred in both groups equally and ranged from 0.3% to 14%. Restenosis was observed in both groups in the range of 4% to 5%. High fetal loss of around 20% mortality was witnessed in pregnant mitral stenosis patients undergoing open heart surgery. It's time to re-envision CMV since it is providing substantial outcomes and remitting the need for open-heart surgery at a very low cost in patients with mitral stenosis with a pliable valve.
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Tratamiento quirúrgico de la insuficiencia mitral reumática. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Uy J, Ketkar AG, Portnoy A, Kim JJ. Cost-utility analysis of heart surgeries for young adults with severe rheumatic mitral valve disease in India. Int J Cardiol 2021; 338:50-57. [PMID: 34090957 DOI: 10.1016/j.ijcard.2021.05.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/30/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Rheumatic mitral valve disease (RMVD) is a major cause of acquired valvular disease in India. We compared the cost-effectiveness of surgical treatment strategies for young adults with severe RMVD from an Indian public payer perspective. METHODS We developed a Markov model to reflect the burden of RMVD among a hypothetical cohort of 20-year-olds in India and to estimate quality-adjusted life years (QALYs) and lifetime costs associated with three strategies: (1) Repair; (2) Mechanical valve replacement (MVR-M); and (3) Bioprosthetic valve replacement (MVR-B), compared to a baseline strategy involving a mix of surgeries approximating the standard of care in India (32% Repair, 33% MVR-M, 35% MVR-B). Data on disease burden, intervention effects, and direct medical costs (2018 US$) were obtained from the literature. Deterministic and probabilistic sensitivity analyses were conducted to assess model uncertainty. RESULTS Repair ($2530, 9.7 QALYs) was less costly and more effective than the standard of care ($2990, 8.7 QALYs) and MVR-M ($3220, 6.2 QALYs). The incremental cost-effective ratio for MVR-B ($3190, 10.1 QALYs) compared to Repair was $1590 per QALY, which may be cost-effective at a threshold of India's per-capita gross domestic product (GDP: $2005). The optimal choice between Repair or MVR-B was sensitive to variations in surgery costs, background mortality, and risks for reoperation. CONCLUSIONS Our model-based analysis suggests that Repair is the optimal strategy and MVR-M should not be recommended for this subpopulation. MVR-B may be cost-effective in contexts where quality of Repair is not assured, newer generation bioprostheses are used, or the costs of the bioprosthetic valve decrease.
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Affiliation(s)
- Jhanna Uy
- Health Sciences Program, School of Science and Engineering, Ateneo de Manila University, Metro Manila, Philippines.
| | | | - Allison Portnoy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Jane J Kim
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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