1
|
Fall N, Odong F, Thembo J, Pulle J, Hoekzema J, Rwebembera J, de Loizaga S, Nakagaayi D, Minja N, Webel A, Watkins D, Beaton A. User-Centered Design to Develop Automated Short Message Service Messaging for Patient Support of Rheumatic Heart Disease Secondary Antibiotic Prophylaxis. J Am Heart Assoc 2024; 13:e031252. [PMID: 38226514 PMCID: PMC10926829 DOI: 10.1161/jaha.123.031252] [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: 06/05/2023] [Accepted: 10/31/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND The Active Community Case Management Platform is a cloud-based technology developed to facilitate rheumatic heart disease case management by health care providers. This study aimed to design and pilot an automated short message service (SMS) intervention to support secondary prophylaxis adherence. METHODS AND RESULTS We developed a concise library of messages to support secondary antibiotic prophylaxis. The SMS intervention used TextIT, an interface that enables users to send out interactive SMS messages at scale. The message bank was piloted in a cohort of 50 patients with rheumatic heart disease randomized into 2 groups. Group 1 received standard support (nurse-led/Active Community Case Management Platform). Group 2 received standard support plus SMS intervention for 2 months in the Lira and Gulu districts of Northern Uganda. We collected qualitative data on participants' experiences and assessed treatment adherence. Using a sequential user-centered process consisting of 4 phases (phases 1-4), we developed a message bank (n=43) deployed during our pilot study. There were no between-group differences in treatment adherence or acceptance. Interviews of participants indicated that the intervention was viewed positively. A total of 75% of SMS recipients responded to the messages, and 25% called the study staff to acknowledge receipt of text messages. CONCLUSIONS This study has successfully developed a bank of SMS messages to support secondary antibiotic prophylaxis adherence. We have demonstrated the feasibility and acceptability of SMS technology in rheumatic heart disease care management. Future work will include integrating automated SMS into the Active Community Case Management Platform and a larger study of integrated SMS to reduce health care worker burden for patient support and improve adherence to secondary antibiotic prophylaxis.
Collapse
Affiliation(s)
- Ndate Fall
- Cincinnati Children’s Hospital Medical CenterCincinnatiOH
| | | | | | | | - Jacob Hoekzema
- Cincinnati Children’s Hospital Medical CenterCincinnatiOH
| | | | | | | | | | | | | | - Andrea Beaton
- Cincinnati Children’s Hospital Medical CenterCincinnatiOH
| |
Collapse
|
2
|
Lamichhane P, Patel F, Al Mefleh R, Mohamed Gasimelseed SY, Ala A, Gawad G, Soni S. Detection and management of latent rheumatic heart disease: a narrative review. Ann Med Surg (Lond) 2023; 85:6048-6056. [PMID: 38098553 PMCID: PMC10718380 DOI: 10.1097/ms9.0000000000001402] [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: 07/27/2023] [Accepted: 10/08/2023] [Indexed: 12/17/2023] Open
Abstract
Rheumatic heart disease (RHD) is a public health concern in many developing nations around the world. Early detection of latent or subclinical RHD can help in reversing mild lesions, retarding disease progression, reducing morbidity and mortality, and improving the quality of life of patients. Echocardiography is the gold-standard method for screening and confirming latent RHD cases. The rates and determinants of progression of latent RHD cases as assessed by echocardiography have been found to be variable through studies. Even though latent RHD has a slow rate of progression, the rate of progression of its subtype, 'definite' RHD, is substantial. A brief training of nonexpert operators on the use of handheld echocardiography with a simplified protocol is an important strategy to scale up the screening program to detect latent cases. Newer advancements in screening, such as deep-learning digital stethoscopes and telehealth services, have provided an opportunity to expand screening programs even in resource-constrained settings. Newer studies have established the efficacy and safety profile of secondary antibiotic prophylaxis in latent RHD. The concerned authorities in endemic regions of the world should work on improving the availability and accessibility of antibiotic prophylaxis.
Collapse
Affiliation(s)
| | - Fiuna Patel
- American University of Barbados School of Medicine, Wildey, Barbados
| | - Renad Al Mefleh
- Department of Pediatrics, Jordanian Royal Medical Services, Amman, Jordan
| | | | - Abdul Ala
- Faculty of Pharmacy, University of Tripoli, Tripoli, Libya
| | - Gamal Gawad
- Saba University School of Medicine, Saba, Dutch Caribbean
| | - Siddharath Soni
- Department of General Medicine, Shree Narayan Medical Institute and Hospital, Saharsa, Bihar Bihar, India
| |
Collapse
|
3
|
Govender K, Müller A. Secondary Prophylaxis Among First Nations People With Acute Rheumatic Fever in Australia: An Integrative Review. J Transcult Nurs 2023; 34:443-452. [PMID: 37572036 PMCID: PMC10637076 DOI: 10.1177/10436596231191248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023] Open
Abstract
INTRODUCTION The prevalence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) among Australia's First Nations populations are some of the highest in the world, accounting for 95% of the 2,244 ARF notifications between 2015 and 2019 in Australia. A key issue in treating ARF is long-term secondary prophylaxis, yet only one in five patients received treatment in 2019. This review identifies barriers to secondary prophylaxis of ARF in Australia's First Nations people. METHODS An integrative review was undertaken utilizing PubMed, CINAHL, ProQuest, and Wiley Online. Joanna Briggs Institute critical appraisal tools were used, followed by thematic analysis. RESULTS The key themes uncovered included: issues with database and recall systems, patient/family characteristics, service delivery location and site, pain of injection, education (including language barriers), and patient-clinician relationship. CONCLUSIONS A national RHD register, change in operation model, improved pain management, improved education, and need for consistent personnel is suggested.
Collapse
Affiliation(s)
| | - Amanda Müller
- Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
4
|
de Loizaga SR, Pulle J, Rwebembera J, Abrams J, Atala J, Chesnut E, Danforth K, Fall N, Felicelli N, Lapthorn K, Longenecker CT, Minja NW, Moore RA, Morrison R, Mwangi J, Nakagaayi D, Nakitto M, Sable C, Sanyahumbi A, Sarnacki R, Thembo J, Vincente SL, Watkins D, Zühlke L, Okello E, Beaton A, Dexheimer JW. Development and User Testing of a Dynamic Tool for Rheumatic Heart Disease Management. Appl Clin Inform 2023; 14:866-877. [PMID: 37914157 PMCID: PMC10620041 DOI: 10.1055/s-0043-1774812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/08/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE Most rheumatic heart disease (RHD) registries are static and centralized, collecting epidemiological and clinical data without providing tools to improve care. We developed a dynamic cloud-based RHD case management application with the goal of improving care for patients with RHD in Uganda. METHODS The Active Community Case Management Tool (ACT) was designed to improve community-based case management for chronic disease, with RHD as the first test case. Global and local partner consultation informed selection of critical data fields and prioritization of application functionality. Multiple stages of review and revision culminated in user testing of the application at the Uganda Heart Institute. RESULTS Global and local partners provided feedback of the application via survey and interview. The application was well received, and top considerations included avenues to import existing patient data, considering a minimum data entry form, and performing a situation assessment to tailor ACT to the health system setup for each new country. Test users completed a postuse survey. Responses were favorable regarding ease of use, desire to use the application in regular practice, and ability of the application to improve RHD care in Uganda. Concerns included appropriate technical skills and supports and potential disruption of workflow. CONCLUSION Creating the ACT application was a dynamic process, incorporating iterative feedback from local and global partners. Results of the user testing will help refine and optimize the application. The ACT application showed potential for utility and integration into existing care models in Uganda.
Collapse
Affiliation(s)
- Sarah R. de Loizaga
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States
| | - Jafesi Pulle
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
| | | | - Jessica Abrams
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Reach, Cape Town, South Africa
| | - Jenifer Atala
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
| | - Emily Chesnut
- Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Kristen Danforth
- Department of Global Health & Division of Cardiology, University of Washington, Seattle, Washington, United States
| | - Ndate Fall
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Nicholas Felicelli
- Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Karen Lapthorn
- Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Chris T. Longenecker
- Department of Global Health & Division of Cardiology, University of Washington, Seattle, Washington, United States
| | - Neema W. Minja
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
| | - Ryan A. Moore
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States
| | - Riley Morrison
- Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | | | | | - Miriam Nakitto
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
| | - Craig Sable
- Department of Cardiology, Children's National Medical Center, Washington, District of Columbia, United States
| | - Amy Sanyahumbi
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, United States
| | - Rachel Sarnacki
- Department of Cardiology, Children's National Medical Center, Washington, District of Columbia, United States
| | | | | | - David Watkins
- Department of Global Health & Division of Cardiology, University of Washington, Seattle, Washington, United States
| | - Liesl Zühlke
- Division of Cardiology and Paediatric Cardiology, Department of Medicine/Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Emmy Okello
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
| | - Andrea Beaton
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States
| | - Judith W. Dexheimer
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States
- Division of Emergency Medicine and Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| |
Collapse
|
5
|
Shimanda PP, Söderberg S, Iipinge SN, Lindholm L, Shidhika FF, Norström F. Health-related quality of life and healthcare consultations among adult patients before and after diagnosis with rheumatic heart disease in Namibia. BMC Cardiovasc Disord 2023; 23:456. [PMID: 37704961 PMCID: PMC10500941 DOI: 10.1186/s12872-023-03504-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Rheumatic Heart Disease (RHD) causes high morbidity and mortality rates among children and young adults, impacting negatively on their health-related quality of life (HRQoL). This study aimed to evaluate the HRQoL and healthcare consultations of adult patients with RHD in Namibia. METHODS From June 2019 to March 2020, a questionnaire was administered to 83 RHD patients during routine follow-ups. The EQ-5D-5L instrument was used to assess the health-related quality of life before diagnosis and at the time of the survey. The Ethiopian value set for EQ-5D-5L was used to calculate Quality-Adjusted Life Years (QALY). RESULTS Most respondents were women (77%), young adults below the age of 30 years (42%), and individuals who grew up in rural areas (87%). The mean QALY statistically significantly improved from 0.773 pre-diagnosis to 0.942 in the last 12 months (p < 0.001). Sixty-six patients who had surgery reported a better QALY. Healthcare visits statistically significantly increased from on average 1.6 pre-diagnosis to 2.7 days in the last 12 months (p < 0.001). The mean distance to the nearest facility was 55 km, mean cost of transport was N$65, and mean time spent at the clinic was 3.6 h. The median time from diagnosis to the survey was 7 years (quartiles 4 and 14 years). CONCLUSION Treatment and surgery can improve HRQoL substantially among RHD patients. Being diagnosed with RHD affects patients living in socioeconomically disadvantaged rural areas through cost and time for healthcare visits. It would be valuable with further research to understand differences between disease severities.
Collapse
Affiliation(s)
- Panduleni Penipawa Shimanda
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, SE, Sweden.
- Clara Barton School of Nursing, Welwitchia Health Training Centre, Pelican Square, P.O. Box 1835, Windhoek, Namibia.
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Cardiology, Umeå, SE, Sweden
| | - Scholastika Ndatinda Iipinge
- Clara Barton School of Nursing, Welwitchia Health Training Centre, Pelican Square, P.O. Box 1835, Windhoek, Namibia
| | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, SE, Sweden
| | | | - Fredrik Norström
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, SE, Sweden
| |
Collapse
|
6
|
Hla TK, Osowicki J, Salman S, Batty KT, Marsh JA, Kado J, Barr R, Enkel SL, Snelling TL, McCarthy J, Steer AC, Carapetis J, Manning L. Study protocol for controlled human infection for penicillin G against Streptococcus pyogenes: a double-blinded, placebo-controlled, randomised trial to determine the minimum concentration required to prevent experimental pharyngitis (the CHIPS trial). BMJ Open 2022; 12:e064022. [PMID: 36600395 PMCID: PMC9743388 DOI: 10.1136/bmjopen-2022-064022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Regular intramuscular benzathine penicillin G injections have been the cornerstone of rheumatic heart disease (RHD) secondary prophylaxis since the 1950s. As the pharmacological correlate of protection remains unknown, it is difficult to recommend changes to this established regimen. Determining the minimum effective penicillin exposure required to prevent Streptococcus pyogenes infection will accelerate development of new long-acting penicillins for RHD prevention as well as inform opportunities to improve existing regimens. The CHIPS trial will address this knowledge gap by directly testing protection afforded by different steady state plasma concentrations of penicillin in an established model of experimental human S. pyogenes pharyngitis. METHODS AND ANALYSIS This is a double-blinded, placebo-controlled, randomised experimental human infection study. Sixty healthy adult volunteers aged 18-40 years will be recruited and randomised 1:1:1:1:1 to continuous intravenous penicillin infusions targeting five different steady state plasma concentrations of 0 (placebo), 3, 6, 12 and 20 ng/mL via a midline catheter. Each participant's penicillin pharmacokinetic parameters will be established prior to the challenge, to ensure accurate dosing for the continuous infusion. Following the challenge with a well-characterised strain of S. pyogenes, participants will be observed for up to 6 days for the development of pharyngitis and treated with antibiotics prior to discharge. The primary objective is to determine the minimum effective steady-state plasma penicillin concentration required to prevent experimental pharyngitis. Secondary objectives will explore systemic and mucosal immunoinflammatory responses during pharyngitis, bacterial colonisation dynamics, environmental contamination and qualitative evaluation of the participant experience. ETHICS AND DISSEMINATION Ethical approval has been obtained (Bellberry Human Research Ethics Committee). Findings will be reported in peer-reviewed publications and presented at national/international stakeholder forums. TRIAL REGISTRATION NUMBER ACTRN12621000751875.
Collapse
Affiliation(s)
- Thel Khin Hla
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Joshua Osowicki
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Infectious Diseases Unit, Royal Children's Hospital Melbourne Department of General Medicine, Parkville, Victoria, Australia
| | - Sam Salman
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Kevin T Batty
- Curtin University, Perth, Western Australia, Australia
| | - Julie A Marsh
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Joseph Kado
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Renae Barr
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Stephanie L Enkel
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Thomas L Snelling
- The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | | | - Andrew C Steer
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Infectious Diseases Unit, Royal Children's Hospital Melbourne Department of General Medicine, Parkville, Victoria, Australia
| | - Jonathan Carapetis
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Laurens Manning
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| |
Collapse
|
7
|
Shimanda PP, Söderberg S, Iipinge SN, Neliwa EM, Shidhika FF, Norström F. Rheumatic heart disease prevalence in Namibia: a retrospective review of surveillance registers. BMC Cardiovasc Disord 2022; 22:266. [PMID: 35701751 PMCID: PMC9196853 DOI: 10.1186/s12872-022-02699-2] [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: 01/17/2022] [Accepted: 06/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background Rheumatic heart disease (RHD) is the most commonly acquired heart disease in children and young people in low and middle-income settings. Fragile health systems and scarcity of data persist to limit the understanding of the relative burden of this disease. The aims of this study were to estimate the prevalence of RHD and to assess the RHD-related health care systems in Namibia. Methods Data was retrieved from outpatient and inpatient registers for all patients diagnosed and treated for RHD between January 2010 to December 2020. We used descriptive statistics to estimate the prevalence of RHD. Key observations and engagement with local cardiac clinicians and patients helped to identify key areas of improvement in the systems. Results The outpatient register covered 0.032% of the adult Namibian population and combined with the cumulative incidence from the inpatient register we predict the prevalence of clinically diagnosed RHD to be between 0.05% and 0.10% in Namibia. Young people (< 18 years old) are most affected (72%), and most cases are from the north-eastern regions. Mitral heart valve impairment (58%) was the most common among patients. We identified weaknesses in care systems i.e., lack of patient unique identifiers, missing data, and clinic-based prevention activities. Conclusion The prevalence of RHD is expected to be lower than previously reported. It will be valuable to investigate latent RHD and patient follow-ups for better estimates of the true burden of disease. Surveillance systems needs improvements to enhance data quality. Plans for expansions of the clinic-based interventions must adopt the “Awareness Surveillance Advocacy Prevention” framework supported by relevant resolutions by the WHO.
Collapse
Affiliation(s)
- Panduleni Penipawa Shimanda
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden. .,Clara Barton School of Nursing, Welwitchia Health Training Centre, Pelican Square, Windhoek, P. o. Box 1835, Namibia.
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, 901 87, Sweden
| | - Scholastika Ndatinda Iipinge
- Clara Barton School of Nursing, Welwitchia Health Training Centre, Pelican Square, Windhoek, P. o. Box 1835, Namibia
| | | | - Fenny Fiindje Shidhika
- Department of Paediatric and Congenital Cardiology, Windhoek Central Hospital, Windhoek, Namibia
| | - Fredrik Norström
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
| |
Collapse
|
8
|
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
|
9
|
de Loizaga SR, Beaton AZ, Nascimento BR, Macedo FVB, Spolaor BCM, de Pádua LB, Ribeiro TFS, Oliveira GCF, Oliveira LR, de Almeida LFR, Moura TD, de Barros TT, Sable C, Nunes MCP. Diagnosing rheumatic heart disease: where are we now and what are the challenges? Expert Rev Cardiovasc Ther 2021; 19:777-786. [PMID: 34424119 DOI: 10.1080/14779072.2021.1970531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Rheumatic heart disease (RHD), a sequela of acute rheumatic fever (ARF), affects 40.5 million people worldwide. The burden of disease disproportionately falls on low- and middle-income countries (LMIC) and sub-populations within high-income countries (HIC). Advances have been made in earlier detection of RHD, though several barriers to ideal management persist. AREAS COVERED This article reviews the current burden of RHD, highlighting the disparate impact of disease. It also reviews the clinical and echocardiographic presentation of RHD, as some may present in late stages of disease with associated complications. Finally, we review the advances which have been made in echocardiographic screening to detect latent RHD, highlighting the challenges which remain regarding secondary prophylaxis management and uncertainty of best practices for treatment of latent RHD. EXPERT OPINION Advances in technology and validation of portable echocardiography have made screening and identifying latent RHD feasible in the most burdened regions. However, uncertainty remains around best management of those with latent RHD and best methods to ensure ideal secondary prophylaxis for RHD. Research regarding latent RHD management, as well as continued work on innovative solutions (such as group A streptococcal vaccine), are promising as efforts to improve outcomes of this preventable disease persist.
Collapse
Affiliation(s)
- Sarah R de Loizaga
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Andrea Z Beaton
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,University of Cincinnati School of Medicine, Cincinnati, Oh, United States
| | - Bruno R Nascimento
- Hospital das Clínicas da Ufmg, Belo Horizonte, MG, Brazil.,Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Mg, Brazil
| | | | | | - Lucas Bretas de Pádua
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | - Lucas Rocha Oliveira
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | | | - Craig Sable
- Children's National Hospital, Washington, DC, USA
| | - Maria Carmo Pereira Nunes
- Hospital das Clínicas da Ufmg, Belo Horizonte, MG, Brazil.,Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Mg, Brazil
| |
Collapse
|
10
|
Kado JH, Salman S, Henderson R, Hand R, Wyber R, Page-Sharp M, Batty K, Carapetis J, Manning L. Subcutaneous administration of benzathine benzylpenicillin G has favourable pharmacokinetic characteristics for the prevention of rheumatic heart disease compared with intramuscular injection: a randomized, crossover, population pharmacokinetic study in healthy adult volunteers. J Antimicrob Chemother 2021; 75:2951-2959. [PMID: 32696033 DOI: 10.1093/jac/dkaa282] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Benzathine penicillin G has been used as monthly deep intramuscular (IM) injections since the 1950s for secondary prevention of acute rheumatic fever and rheumatic heart disease (RHD). Injection frequency and pain are major programmatic barriers for adherence, prompting calls for development of better long-acting penicillin preparations to prevent RHD. We hypothesized that subcutaneous (SC) administration of benzathine penicillin G could delay penicillin absorption when compared with IM injections. METHODS To compare the pharmacokinetic profile and tolerability of benzathine penicillin G according to different routes of administration, 15 healthy males participated in a randomized crossover study to receive benzathine penicillin G by either SC or IM routes, with a 10 week washout period before the second dose by the alternative route. Ultrasound guidance confirmed injection location. Penicillin concentrations and pain scores were measured for 6 weeks following injections. RESULTS SC administration was well tolerated with no significant differences in pain scores. Following SC injection, the principal absorption half-life (95% CI) was 20.1 (16.3-29.5) days and 89.6% (87.1%-92.0%) of the drug was directed via this pathway compared with 10.2 (8.6-12.5) days and 71.3% (64.9%-77.4%) following IM administration. Lower peak and higher trough penicillin concentrations resulted following SC injection. Simulations demonstrated that SC infusion of higher doses of benzathine penicillin G could provide therapeutic penicillin concentrations for 3 months. CONCLUSIONS SC administration of benzathine penicillin G is safe and significantly delays penicillin absorption. High-dose benzathine penicillin G via the SC route would fulfil many product characteristics required for the next generation of longer-acting penicillins for use in RHD.
Collapse
Affiliation(s)
- Joseph H Kado
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Sam Salman
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Robert Henderson
- Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Robert Hand
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Rosemary Wyber
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.,The George Institute of Global Health, University of Sydney, Sydney, New South Wales, Australia
| | - Madhu Page-Sharp
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Kevin Batty
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Jonathan Carapetis
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Laurens Manning
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.,Fiona Stanley Hospital, Murdoch, WA 6150, Australia
| |
Collapse
|
11
|
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
|
12
|
Wyber R, Noonan K, Halkon C, Enkel S, Cannon J, Haynes E, Mitchell AG, Bessarab DC, Katzenellenbogen JM, Bond-Smith D, Seth R, D'Antoine H, Ralph AP, Bowen AC, Brown A, Carapetis JR. Ending rheumatic heart disease in Australia: the evidence for a new approach. Med J Aust 2020; 213 Suppl 10:S3-S31. [PMID: 33190287 DOI: 10.5694/mja2.50853] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
■The RHD Endgame Strategy: the blueprint to eliminate rheumatic heart disease in Australia by 2031 (the Endgame Strategy) is the blueprint to eliminate rheumatic heart disease (RHD) in Australia by 2031. Aboriginal and Torres Strait Islander people live with one of the highest per capita burdens of RHD in the world. ■The Endgame Strategy synthesises information compiled across the 5-year lifespan of the End Rheumatic Heart Disease Centre of Research Excellence (END RHD CRE). Data and results from priority research projects across several disciplines of research complemented literature reviews, systematic reviews and narrative reviews. Further, the experiences of those working in acute rheumatic fever (ARF) and RHD control and those living with RHD to provide the technical evidence for eliminating RHD in Australia were included. ■The lived experience of RHD is a critical factor in health outcomes. All future strategies to address ARF and RHD must prioritise Aboriginal and Torres Strait Islander people's knowledge, perspectives and experiences and develop co-designed approaches to RHD elimination. The environmental, economic, social and political context of RHD in Australia is inexorably linked to ending the disease. ■Statistical modelling undertaken in 2019 looked at the economic and health impacts of implementing an indicative strategy to eliminate RHD by 2031. Beginning in 2019, the strategy would include: reducing household crowding, improving hygiene infrastructure, strengthening primary health care and improving secondary prophylaxis. It was estimated that the strategy would prevent 663 deaths and save the health care system $188 million. ■The Endgame Strategy provides the evidence for a new approach to RHD elimination. It proposes an implementation framework of five priority action areas. These focus on strategies to prevent new cases of ARF and RHD early in the causal pathway from Streptococcus pyogenes exposure to ARF, and strategies that address the critical systems and structural changes needed to support a comprehensive RHD elimination strategy.
Collapse
Affiliation(s)
- Rosemary Wyber
- George Institute for Global Health, Sydney, NSW.,Telethon Kids Institute, Perth, WA
| | | | | | | | | | | | | | | | | | | | - Rebecca Seth
- Telethon Kids Institute, Perth, WA.,University of Western Australia, Perth, WA
| | | | | | - Asha C Bowen
- Telethon Kids Institute, Perth, WA.,Perth Children's Hospital, Perth, WA
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, SA.,University of South Australia, Adelaide, SA
| | | | | |
Collapse
|
13
|
Gutman SJ, Shemesh E, Marwick TH, Taylor AJ. Echocardiographic screening to determine progression of latent rheumatic heart disease in endemic areas: A systematic review and meta-analysis. PLoS One 2020; 15:e0234196. [PMID: 32497088 PMCID: PMC7272083 DOI: 10.1371/journal.pone.0234196] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/20/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The World Health Organisation previously recommended routine screening in school-aged children in countries with a high prevalence of rheumatic heart disease (RHD); however, it is unclear if screening-detected (latent) valve disease will inevitably evolve to a pathological lesion. Understanding the natural history of latent RHD is essential prior to recommendation of screening in endemic areas. Studies documenting the progression of latent RHD have had contrasting conclusions about the pathogenicity of latent valvular lesions. This review provides estimates of rates of progression of latent RHD. METHODS AND FINDINGS In this systematic review and meta-analysis, we searched EMBASE, MEDLINE, Global Index Medicus, Africa Wide, Cochrane Database of Systematic Reviews and Global Health Database for studies published before April 30, 2019. Study data were extracted from all studies which reported follow-up data on progression of latent valve lesions. Studies with control cohorts were used to calculate comparative prevalence ratios. This study is registered with PROSPERO, number CRD42019119427. We identified 12 studies reporting follow-up data on latent RHD for 950 people in 9 countries. The estimated pooled prevalence rate for progression per year of latent RHD was 5%/year (95% CI 2-8). Eight studies reported on the progression of borderline latent RHD with an estimated pooled prevalence of 2%/year (95% CI 0-4). Three studies included control groups. There was a significant increase in the risk of progression of valvular disease in the latent group compared with controls (RR = 3.57 (95%CI = 1.65-7.70, P = 0.001). The overall risk of bias was low. Given most studies included penicillin administration we were unable to document the natural history of latent RHD. Furthermore, we were unable to perform a sensitivity analysis to determine the effect of administering penicillin prophylaxis on progression of valve disease given prescription of penicillin was not standardised. CONCLUSION Latent RHD has a slow rate of progression but it is significantly higher compared to controls, with definite latent RHD having a higher rate of progression compared with borderline latent disease. There are a massive number of individuals at risk for RHD in the developing world as well as logistical challenges of screening and delivering penicillin prophylaxis. The low rate of progression from untargeted screening may be an important consideration in resource-constrained environments.
Collapse
Affiliation(s)
- Sarah J. Gutman
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Department of Cardiology, The Alfred Hospital, Melbourne, Australia
- Monash University, Melbourne, Australia
| | - Elad Shemesh
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Thomas H. Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Department of Cardiology, The Alfred Hospital, Melbourne, Australia
- Monash University, Melbourne, Australia
| | - Andrew J. Taylor
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Department of Cardiology, The Alfred Hospital, Melbourne, Australia
- Monash University, Melbourne, Australia
| |
Collapse
|
14
|
Haynes E, Mitchell A, Enkel S, Wyber R, Bessarab D. Voices behind the Statistics: A Systematic Literature Review of the Lived Experience of Rheumatic Heart Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041347. [PMID: 32093099 PMCID: PMC7068492 DOI: 10.3390/ijerph17041347] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 01/22/2023]
Abstract
In Australia, Aboriginal children almost entirely bear the burden of acute rheumatic fever (ARF) which often leads to rheumatic heart disease (RHD), a significant marker of inequity in Indigenous and non-Indigenous health experiences. Efforts to eradicate RHD have been unsuccessful partly due to lack of attention to voices, opinions and understandings of the people behind the statistics. This systematic review presents a critical, interpretive analysis of publications that include lived experiences of RHD. The review approach was strengths-based, informed by privileging Indigenous knowledges, perspectives and experiences, and drawing on Postcolonialism and Critical Race Theory. Fifteen publications were analysed. Nine themes were organised into three domains which interact synergistically: sociological, disease specific and health service factors. A secondary sociolinguistic analysis of quotes within the publications articulated the combined impact of these factors as ‘collective trauma’. Paucity of qualitative literature and a strong biomedical focus in the dominant narratives regarding RHD limited the findings from the reviewed publications. Noteworthy omissions included: experiences of children/adolescents; evidence of Indigenous priorities and perspectives for healthcare; discussions of power; recognition of the centrality of Indigenous knowledges and strengths; and lack of critical reflection on impacts of a dominant biomedical approach to healthcare. Privileging a biomedical approach alone is to continue colonising Indigenous healthcare.
Collapse
Affiliation(s)
- Emma Haynes
- School of Population and Global Health, The University of Western Australia, Perth 6000, Australia
- Telethon Kids Institute, Perth 6000, Australia; (S.E.); (R.W.)
- Correspondence:
| | - Alice Mitchell
- Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia;
| | - Stephanie Enkel
- Telethon Kids Institute, Perth 6000, Australia; (S.E.); (R.W.)
| | - Rosemary Wyber
- Telethon Kids Institute, Perth 6000, Australia; (S.E.); (R.W.)
- The George Institute for Global Health, University of New South Wales, Sydney 2000, Australia
| | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental Health, The University of Western Australia, Perth 6000, Australia;
| |
Collapse
|
15
|
Liaw JY, White AV, Gorton S, Axford-Haines L. Lessons to be learned: Using National Immunisation strategies to improve adherence to acute rheumatic fever secondary prophylaxis. J Paediatr Child Health 2019; 55:1170-1176. [PMID: 31410921 DOI: 10.1111/jpc.14596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/22/2019] [Accepted: 07/25/2019] [Indexed: 11/29/2022]
Abstract
Rheumatic heart disease, as a result of a single or recurrent episode of acute rheumatic fever (ARF), remains a significant cause of morbidity and mortality in northern and remote Australia; ARF has a peak incidence among 5-14-year-old Aboriginal and Torres Strait Islander children. Long-term regular benzathine penicillin G injections are the only currently successful secondary prevention strategy; however, rates of adherence remain critically low. In contrast, rates of adherence to immunisations on the National Immunisation Program (NIP) Schedule are high, even among this target population. This article compares strategies used to implement and improve ARF secondary prophylaxis with those used in the NIP. Some successful NIP strategies, such as Service Incentive Payment for health providers, home-visiting delivery models and integration into the National Immunisation Register, if applied to ARF secondary prophylaxis have the potential to improve benzathine penicillin G adherence.
Collapse
Affiliation(s)
- Joshua Y Liaw
- Discipline of Child and Adolescent Health, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Andrew V White
- Discipline of Child and Adolescent Health, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Department of Paediatrics, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Susan Gorton
- Discipline of Child and Adolescent Health, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Louise Axford-Haines
- Rheumatic Heart Disease Register and Control Program (Queensland) Public Health Unit, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| |
Collapse
|
16
|
Morberg D, Alzate López Y, Moreira S, Prata N, Riley L, Burroughs Peña M. The rheumatic heart disease healthcare paradox: disease persistence in slums despite universal healthcare coverage—a provider perspective qualitative study. Public Health 2019; 171:15-23. [DOI: 10.1016/j.puhe.2019.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 03/16/2019] [Accepted: 03/20/2019] [Indexed: 01/19/2023]
|
17
|
Holland JV, Hardie K, de Dassel J, Ralph AP. Rheumatic Heart Disease Prophylaxis in Older Patients: A Register-Based Audit of Adherence to Guidelines. Open Forum Infect Dis 2018; 5:ofy125. [PMID: 29942824 PMCID: PMC6009701 DOI: 10.1093/ofid/ofy125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/26/2018] [Indexed: 11/13/2022] Open
Abstract
Background Prevention of rheumatic heart disease (RHD) remains challenging in high-burden settings globally. After acute rheumatic fever (ARF), secondary antibiotic prophylaxis is required to prevent RHD. International guidelines on recommended durations of secondary prophylaxis differ, with scope for clinician discretion. Because ARF risk decreases with age, ongoing prophylaxis is generally considered unnecessary beyond approximately the third decade. Concordance with guidelines on timely cessation of prophylaxis is unknown. Methods We undertook a register-based audit to determine the appropriateness of antibiotic prophylaxis among clients aged ≥35 years in Australia’s Northern Territory. Data on demographics, ARF episode(s), RHD severity, prophylaxis type, and relevant clinical notes were extracted. The determination of guideline concordance was based on whether (1) national guidelines were followed; (2) a reason for departure from guidelines was documented; (3) lifelong continuation was considered appropriate in all cases of severe RHD. Results We identified 343 clients aged ≥35 years prescribed secondary prophylaxis. Guideline concordance was 39% according to national guidelines, 68% when documented reasons for departures from guidelines were included and 82% if patients with severe RHD were deemed to need lifelong prophylaxis. Shorter times since last echocardiogram or cardiologist review were associated with greater likelihood of guideline concordance (P < .001). The median time since last ARF was 5.9 years in the guideline-concordant group and 24.0 years in the nonconcordant group (P < .001). Thirty-two people had an ARF episode after age 40 years. Conclusions In this setting, appropriate discontinuation of RHD prophylaxis could be improved through timely specialist review to reduce unnecessary burden on clients and health systems.
Collapse
Affiliation(s)
| | - Kate Hardie
- Department of Health, Centre for Disease Control, Darwin, Northern Territory, Australia
| | - Jessica de Dassel
- Department of Health, Centre for Disease Control, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anna P Ralph
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| |
Collapse
|
18
|
Abul-Fadl AMAM, Mourad MM, Ghamrawy A, Sarhan AE. Trends in Deaths from Rheumatic Heart Disease in the Eastern Mediterranean Region: Burden and Challenges. J Cardiovasc Dev Dis 2018; 5:E32. [PMID: 29848951 PMCID: PMC6023336 DOI: 10.3390/jcdd5020032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/25/2018] [Accepted: 05/25/2018] [Indexed: 01/19/2023] Open
Abstract
Rheumatic heart disease (RHD) is a preventable disease that is prevalent in developing regions of the world. Its eradication from most of the developed world indicates that this disease can be controlled and eliminated. Aim: To conduct an in-depth analysis of the trends and challenges of controlling RHD in the Eastern Mediterranean region (EMR). Methodology: Global data from the World Health Organization (WHO) data banks were retrieved for total deaths and age standardized death rate per 100,000 (ASDR) by age group, sex, and year (from 2000 to 2015). The data was compared with the five other WHO regions of the world. We also performed in-depth analysis by socio-economic groups in relation to other attributes in the region related to population growth, illiteracy, and nutritional status. Indicators of service delivery were correlated with ASDR from RHD. Findings: Prevalence of RHD in 2015 in the EMR region was one-third of that of the total deaths reported in the Asian and West Pacific regions. The total deaths for the region peaked twice: in early adulthood and again later in old age, and was higher in females than in males. There was a rising trend in deaths from RHD from 2000 to 2015. The highest total deaths were reported from Egypt, Pakistan, Iran, Afghanistan, and Yemen, representing 80% of the total death rates for the region (35,248). The highest ASDR was Afghanistan (27.5), followed by Yemen (18.78) and Egypt (15.59). The ASDR for RHD was highest in low income countries. It correlated highly, in all income groups, with anemia during pregnancy. Conclusions: Trends and patterns of deaths from RHD in the EMR have shifted to a later age group and are linked with poverty related to inequalities in development and service delivery for certain age groups and gender.
Collapse
Affiliation(s)
| | - Maha M Mourad
- Pediatric Department, Pediatric Cardiology Unit, Cairo University, Cairo 11562, Egypt.
| | - Alaa Ghamrawy
- Non communicable Disease Department, Ministry of Health and Population, Cairo 11562 Egypt.
| | - Ayah Ebada Sarhan
- Department of Psychology, American University in Cairo, Fifth settlement, Cairo 11835, Egypt.
| |
Collapse
|
19
|
Myint NPST, Aung NM, Win MS, Htut TY, Ralph AP, Cooper DA, Nyein ML, Kyi MM, Hanson J. The clinical characteristics of adults with rheumatic heart disease in Yangon, Myanmar: An observational study. PLoS One 2018; 13:e0192880. [PMID: 29466408 PMCID: PMC5821331 DOI: 10.1371/journal.pone.0192880] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/31/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) is a major cause of premature death in low and middle-income countries. The greatest barrier to RHD control is neglect of the disease in national health policies and a lack of prevalence data that might inform control efforts. Myanmar is making remarkable progress against many infectious diseases, but there are almost no data to define the clinical burden of RHD in the country. This prospective audit was performed in an adult medical ward of a tertiary-referral hospital in Yangon, to gain an insight into the prevalence of RHD in Myanmar. PRINCIPAL FINDINGS All patients admitted to the ward between May 1, 2016 and April 30, 2017 were eligible for enrolment. RHD was confirmed in 96 patients who were admitted on 134 occasions, representing 1.1% of the 12,172 adult medical admissions during the study period. This compared with 410 (3.4%) admissions with HIV and 14 (0.1%) with malaria. Patients with RHD had a median age of 44 years (interquartile range: 35-59); 70 (73%) were female. Only one patient had ever had surgery despite 79 (82%) meeting criteria for intervention; 54 (56%) patients were not receiving any regular clinician review. Prior to hospitalisation only 18 (19%) patients were receiving regular penicillin. Only 8 (19%) of the 42 women <50 years were using contraception. Of 49 patients who had been hospitalised previously, 22 (45%) were receiving no regular therapy. During the study three (3.1%) patients died, and 28 (29%) were lost to follow-up. Of the 65 (68%) alive and retained in care, 21 (32%) were still experiencing moderate-severe RHD-related symptoms at the study's end. CONCLUSIONS There is a significant and unmet clinical burden of RHD in Myanmar. A national RHD programme would improve patient care, reducing morbidity and mortality from this preventable disease.
Collapse
Affiliation(s)
- Nan Phyu Sin Toe Myint
- Department of Medicine, Insein General Hospital, Yangon, Myanmar
- University of Medicine 2, Yangon, Myanmar
| | - Ne Myo Aung
- Department of Medicine, Insein General Hospital, Yangon, Myanmar
- University of Medicine 2, Yangon, Myanmar
| | - Myint Soe Win
- Department of Cardiology, North Okkalapa General Hospital, Yangon, Myanmar
| | - Thu Ya Htut
- Department of Medicine, Insein General Hospital, Yangon, Myanmar
| | - Anna P. Ralph
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - David A. Cooper
- Director’s Unit, Kirby Institute, University of New South Wales, Sydney, Australia
| | - Myo Lwin Nyein
- University of Medicine 2, Yangon, Myanmar
- Department of Cardiology, North Okkalapa General Hospital, Yangon, Myanmar
| | - Mar Mar Kyi
- Department of Medicine, Insein General Hospital, Yangon, Myanmar
- University of Medicine 2, Yangon, Myanmar
| | - Josh Hanson
- University of Medicine 2, Yangon, Myanmar
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Director’s Unit, Kirby Institute, University of New South Wales, Sydney, Australia
| |
Collapse
|
20
|
Mitchell AG, Belton S, Johnston V, Read C, Scrine C, Ralph AP. Aboriginal children and penicillin injections for rheumatic fever: how much of a problem is injection pain? Aust N Z J Public Health 2017; 42:46-51. [PMID: 29168304 DOI: 10.1111/1753-6405.12737] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 06/01/2017] [Accepted: 09/01/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore young Aboriginal people's and clinicians' experiences of injection pain for the 10 years of penicillin injections children are prescribed to prevent rheumatic fever recurrences. METHODS Aboriginal children on the penicillin regimen and clinicians were purposively recruited from four remote sites in Australia. Semi-structured interviews and participant observations were conducted. Views were synthesised and thematically analysed. RESULTS A total of 29 Aboriginal children and 59 clinicians were interviewed. Sixteen participants appeared to become accustomed to the injection pain, eight did not find pain an issue, and five found injection pain difficult. A further five believed the injections made them unwell. Patients expressed varying abilities to negotiate with clinicians about the use of pain reduction measures. Clinicians revealed good knowledge of pain reduction measures, but offered them inconsistently. All clinicians found administering the injections distressing. CONCLUSION Repeated painful procedures in children necessitate well-planned and child-focused care. Current practices are not in line with guidance from the Royal Australasian College of Physicians about effects of repeated painful procedures on children. Initiating the long-term injection regimen for rheumatic fever is a special event requiring expert input. A newly reported finding of a subset of young people feeling unwell after receiving the injection requires further investigation. Implications for public health: Improvement of local and jurisdictional guidelines on use of pain reduction measures for children who have been prescribed repeated painful injections for rheumatic fever is needed.
Collapse
Affiliation(s)
- Alice G Mitchell
- Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Suzanne Belton
- Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Vanessa Johnston
- Menzies School of Health Research, Charles Darwin University, Northern Territory
| | | | | | - Anna P Ralph
- Menzies School of Health Research, Charles Darwin University, Northern Territory.,Division of Medicine, Royal Darwin Hospital, Northern Territory
| |
Collapse
|
21
|
Barker H, Oetzel JG, Scott N, Morley M, Carr PEA, Oetzel KB. Enablers and barriers to secondary prophylaxis for rheumatic fever among Māori aged 14-21 in New Zealand: a framework method study. Int J Equity Health 2017; 16:201. [PMID: 29149897 PMCID: PMC5693496 DOI: 10.1186/s12939-017-0700-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/14/2017] [Indexed: 12/03/2022] Open
Abstract
Background Acute rheumatic fever (ARF) rates have declined to near zero in nearly all developed countries. However, in New Zealand rates have not declined since the 1980s. Further, ARF diagnoses in New Zealand are inequitably distributed--occurring almost exclusively in Māori (the indigenous population) and Pacific children--with very low rates in the majority New Zealand European population. With ARF diagnosis, secondary prophylaxis is key to prevent recurrence. The purpose of this study was to identify the perceived enablers and barriers to secondary recurrence prophylaxis following ARF for Māori patients aged 14–21. Methods This study took a systems approach, was informed by patient voice and used a framework method to explore potential barriers and enablers to ongoing adherence with monthly antibiotic injections for secondary prophylaxis. Qualitative interviews were conducted with 19 Māori ARF patients receiving recurrence prophylaxis in the Waikato District Health Board region. Participants included those fully adherent to treatment, those with intermittent adherence or those who had been “lost to follow-up.” Results Barriers and enablers were presented around three factors: system (including access/resources), relational and individual. Access and resources included district nurses coming to patients as an enabler and lack of income and time off work as barriers. Relational characteristics included support from family and friends as enablers and district nurse communication as predominantly a positive although not enabling factor. Individual characteristics included understanding, personal responsibility and fear/pain of injections. Conclusion This detailed exploration of barriers and enablers for ongoing secondary prophylaxis provides important new information for the prevention of recurrent ARF. Among other considerations, a national register, innovative engagement with youth and their families and a comprehensive pain management programme are likely to improve adherence to ongoing secondary prophylaxis and reduce the burden of RHD for New Zealand individuals, families and health system.
Collapse
Affiliation(s)
- Hilary Barker
- University of Auckland, Faculty of Medical and Health Sciences, Private Bag 92019, Auckland, 1142, New Zealand
| | - John G Oetzel
- Waikato Management School, University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.
| | - Nina Scott
- Waikato District Health Board, Pembroke Street, Private Bag 3200, Hamilton, 3240, New Zealand
| | - Michelle Morley
- Waikato District Health Board, Pembroke Street, Private Bag 3200, Hamilton, 3240, New Zealand
| | - Polly E Atatoa Carr
- Waikato Management School, University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.,Waikato District Health Board, Pembroke Street, Private Bag 3200, Hamilton, 3240, New Zealand
| | | |
Collapse
|