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Ambari AM, Radi B, Dwiputra B, Arityanti D, Rikl T, Inggriani MP, Qhabibi FR, Susilowati E, Makes IK, Rudiktyo E, Cramer MJ, Doevendans P, Setianto B, Santoso A. Adherence to penicillin treatment is essential for effective secondary prevention of rheumatic heart disease: a systematic review and meta-analysis. Ann Med Surg (Lond) 2024; 86:2116-2123. [PMID: 38576943 PMCID: PMC10990302 DOI: 10.1097/ms9.0000000000001833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/04/2024] [Indexed: 04/06/2024] Open
Abstract
Background Penicillin is essential for secondary prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD). However, the incidences of ARF recurrence and RHD progression remain high, particularly in endemic countries. This meta-analysis evaluated the effectiveness of penicillin adherence in secondary prevention of ARF recurrence and RHD progression. Methods The authors included original articles employing an observational study design in which the study population included patients with ARF or RHD and documented adherence to secondary prophylaxis with penicillin for secondary prevention. Systematic searches of the PubMed, Scopus, and Cochrane databases were performed. Moreover, the authors also conducted a snowballing literature search from Europe PMC to expand the included studies. The quality of each study was assessed using the National Institute of Health Quality Assessment Tool. The statistical analyses were conducted using Review Manager 5.4.1 software developed by Cochrane. In addition, the authors utilized pooled odds ratios (ORs) to compare the adherence techniques. Results A total of 310 studies were identified, of which 57 full-text articles were assessed for eligibility. The authors included six studies with 1364 patients for the qualitative synthesis and meta-analysis. Good adherence to penicillin for the secondary prophylaxis of ARF and RHD, significantly reduced the odds of ARF recurrence or RHD progression by up to 71% compared to that associated with poor adherence [pooled OR 0.29 (0.21-0.40); I²=0% (p=0.56); Z=7.64 (p <0.00001)]. Conclusion Good adherence to penicillin for secondary prophylaxis in patients with ARF or RHD is essential for reducing the risk of ARF recurrence or RHD progression.
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Affiliation(s)
- Ade M. Ambari
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Basuni Radi
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Bambang Dwiputra
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dean Arityanti
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
| | - Thomas Rikl
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Maria P. Inggriani
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
| | - Faqrizal Ria Qhabibi
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
| | - Eliana Susilowati
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
| | - Indira Kalyana Makes
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
| | - Estu Rudiktyo
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | - Pieter Doevendans
- Department of Cardiology, University Medical Centre Utrecht
- Central Military Hospital, Netherlands Heart Institute, Utrecht, The Netherlands
| | - Budhi Setianto
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Anwar Santoso
- Department of Cardiovascular Prevention and Rehabilitation, National Cardiovascular Center Harapan Kita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Shimanda PP, Shumba TW, Brunström M, Iipinge SN, Söderberg S, Lindholm L, Norström F. Preventive Interventions to Reduce the Burden of Rheumatic Heart Disease in Populations at Risk: A Systematic Review. J Am Heart Assoc 2024; 13:e032442. [PMID: 38390809 PMCID: PMC10944073 DOI: 10.1161/jaha.123.032442] [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: 08/30/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Rheumatic heart disease (RHD) is a devastating yet preventable condition that disproportionately affects low-middle-income countries and indigenous populations in some high-income countries. Various preventive interventions have been implemented across the globe, but evidence for the effectiveness of these measures in reducing the incidence or prevalence of acute rheumatic fever and RHD is scattered. This systematic review aims to assess the effectiveness of preventive interventions and identify the strategies used to reduce the burden of RHD. METHODS AND RESULTS A comprehensive search was conducted to identify relevant studies on RHD prevention interventions including interventions for primordial, primary, and secondary prevention. Effectiveness measures for the interventions were gathered when available. The findings indicate that school-based primary prevention services targeting the early detection and treatment of Group A Streptococcus pharyngitis infection with penicillin have the potential to reduce the incidence of Group A Streptococcus pharyngitis and acute rheumatic fever. Community-based programs using various prevention strategies also reduced the burden of RHD. However, there is limited evidence from low-middle-income countries and a lack of rigorous evaluations reporting the true impact of the interventions. Narrative synthesis was performed, and the methodological quality appraisal was done using the Joanna Briggs Institute critical appraisal tools. CONCLUSIONS This systematic review underscores the importance of various preventive interventions in reducing the incidence and burden of Group A Streptococcus pharyngitis, acute rheumatic fever, and RHD. Rigorous evaluations and comprehensive analyses of interventions are necessary for guiding effective strategies and informing public health policies to prevent and reduce the burden of these diseases in diverse populations. REGISTRATION URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42020170503.
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Affiliation(s)
| | - Tonderai W Shumba
- Department of Occupational Therapy and Physiotherapy University of Namibia Windhoek Namibia
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Cardiology Umeå University Umeå Sweden
| | | | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Cardiology Umeå University Umeå Sweden
| | - Lars Lindholm
- Department of Epidemiology and Global Health Umeå University Umeå Sweden
| | - Fredrik Norström
- Department of Epidemiology and Global Health Umeå University Umeå Sweden
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Deane KD. Targeting Environmental Risks to Prevent Rheumatic Disease. Rheum Dis Clin North Am 2022; 48:931-943. [PMID: 36333004 DOI: 10.1016/j.rdc.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Targeting environmental factors can be an important way to reduce the incidence of rheumatic diseases (RDs). Such approaches may be at population levels; furthermore, an emerging ability to identify an individual who is at very high risk for the development of a future RD can allow for personalized approaches to environmental modification for prevention. In this article, we will discuss challenges and opportunities to targeting environmental factors for the prevention of RDs.
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Affiliation(s)
- Kevin D Deane
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Barbara Davis Center (M20), 1775 Aurora Court, Mail Stop B-115, Aurora, CO 80045, USA.
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