747 Poor Domestic Smoke Ventilation is associated With an Increased Risk of Rheumatic Heart Disease in Sri Lankan Children

Atrial fibrillation is said to predispose to embolic stroke. Patients with rheumatic heart disease in atrial fibrillation (AF) are usually treated with warfarin, even though no trial has ever shown that this reduces the risk. Nowadays AF usually has a non-rheumatic cause and is said to carry an increased risk of stroke, but anticoagulation is much less widely practised. Perhaps any association is not causal but simply reflects the coincidence of coronary artery and cerebrovascular disease. Anticoagulation would be worthwhile if it were clear it reduced the risk of embolic stroke and that the benefits exceeded the risks. How clear is the evidence?

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Clinical and Echocardiographic Profile of Patients with Atrial Fibrillation Presenting in Tertiary Care of Nepal

Nepal Mediciti Medical Journal ◽

10.3126/nmmj.v1i1.34452 ◽

2020 ◽

Vol 1 (1) ◽

pp. 1-5

Author(s):

Kumud Bhattarai ◽

Ananta Bhakta Uprety

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Rheumatic Heart Disease ◽

Common Finding ◽

Western World ◽

Presenting Symptoms ◽

Increased Risk ◽

Female Predominance ◽

Common Etiology ◽

Rheumatic Heart

Background: Atrial Fibrillation (AF) is one of the commonest arrhythmias with significant morbidity and mortality where there is uncoordinated activation of atrium leading to mechanical dysfunction of heart. Though rheumatic heart disease is very rare in the western world, it is still prevalent in developing country like Nepal. There is increased risk of development of heart failure, transient ischemic attack/stroke with increased rates of hospitalization. Methods: This study was a descriptive cross sectional study done in 70 admitted cases of two tertiary centres of Kathmandu (Bir Hospital and Sahid Gangalal National Heart Centre) from February 2018 to August 2018, presenting with history and clinical examination suggestive of Atrial Fibrillation and diagnosis confirmed by 12 lead ECG. Results: Among 70 cases, female to male ratio was 2.2:1. The mean age of patients was 60.03 ± 19.60 years with dyspnea (91%) followed by palpitation (76%) being commonest presenting symptoms. 15% of cases presented with Stroke. The most common etiology was rheumatic Heart Disease (38.6%) with female predominance. The most common valvular involvement was of mitral valve (71.4%). 8.6% of patients had clots in Left Atrium and majority had LA size >4cm. Conclusion: In contrary to the studies in the western world, the most common etiology of AF is rheumatic Heart Disease with patients of younger age group with female predominance. Majority of the cases had structural abnormalities in echocardiographic study and left atrial enlargement was common finding risking for thrombus formation and embolization.

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Community-based prevalence of rheumatic heart disease in rural Ethiopia: Five-year follow-up

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009830 ◽

2021 ◽

Vol 15 (10) ◽

pp. e0009830

Author(s):

Tadesse Gemechu ◽

Eldryd H. O. Parry ◽

Magdi H. Yacoub ◽

David I. W. Phillips ◽

Susy Kotit

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

Sub Saharan Africa ◽

Community Based ◽

Increased Risk ◽

The Family ◽

Sub Saharan ◽

Penicillin Prophylaxis ◽

Rheumatic Heart

Background As little is known about the prevalence and clinical progression of subclinical (latent) rheumatic heart disease (RHD) in sub-Saharan Africa, we report the results of a 5 year follow-up of a community based, echocardiographic study of the disease, originally carried out in a rural area around Jimma, Ethiopia. Methods Individuals with evidence of RHD detected during the baseline study as well as controls and their family members were screened with a short questionnaire together with transthoracic echocardiography. Results Of 56 individuals with RHD (37 definite and 19 borderline) in the original study, 36 (26 definite and 10 borderline) were successfully located 57.3 (range 44.9–70.7) months later. At follow-up two thirds of the definite cases still had definite disease; while a third had regressed. Approximately equal numbers of the borderline cases had progressed and regressed. Features of RHD had appeared in 5 of the 60 controls. There was an increased risk of RHD in the family relatives of borderline and definite cases (3.8 and 4.0 times respectively), notably among siblings. Compliance with penicillin prophylaxis was very poor. Conclusions We show the persistence of echocardiographically demonstrable RHD in a rural sub-Saharan population. Both progression and regression of the disease were found; however, the majority of the individuals who had definite features of RHD had evidence of continuing RHD lesions five years later. There was an increased risk of RHD in the family relatives of borderline and definite cases, notably among siblings. The findings highlight the problems faced in addressing the problem of RHD in the rural areas of sub-Saharan Africa. They add to the evidence that community-based interventions for RHD will be required, together with appropriate ways of identifying active disease, achieving adequate penicillin prophylaxis and developing vaccines for primary prevention.

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A hospital-based study of socioeconomic status and clinical spectrum of rheumatic heart disease patients of Assam, North-East India

European Journal of Preventive Cardiology ◽

10.1177/2047487318787333 ◽

2018 ◽

Vol 25 (12) ◽

pp. 1303-1306 ◽

Cited By ~ 6

Author(s):

Lokajeet Baro ◽

Neha Sharma ◽

Devinder Toor ◽

Mriganka S Chaliha ◽

Giriraj Kusre ◽

...

Keyword(s):

Socioeconomic Status ◽

Heart Disease ◽

Rheumatic Heart Disease ◽

Low Socioeconomic Status ◽

Clinical Spectrum ◽

Low Socioeconomic ◽

North East India ◽

North East ◽

Increased Risk ◽

Rheumatic Heart

Objective The aim of this study was to assess the impact of socioeconomic factors in increased prevalence of rheumatic heart disease and its clinical spectrum in Assam, North-East India. Method A case–control questionnaire-based study of 100 echocardiography confirmed rheumatic heart disease cases with age- and sex-matched healthy controls from Assam medical college and hospital in Dibrugarh, Assam was conducted. Results There was a trend toward increased risk of rheumatic heart disease and its clinical spectrum with respect to low socioeconomic status. Three parameters were found to be statistically significant in posing increased risk towards rheumatic heart disease: rural dwelling location ( p < 0.0001, odds ratio (OR) 4.1, 95% confidence interval (CI = 2.29−7.45), low monthly income ( p < 0.001, OR=9.5, 95% CI = 4.99−18.1) and education status ( p < 0.05, OR=9.5, 95% CI = 1.866). Out of the severe cases of mitral stenosis, mitral regurgitation and aortic regurgitation, 69.6%, 58.3% and 34% patients were of low socioeconomic status. Conclusion Socioeconomic factors can be of significant importance in increased prevalence of rheumatic heart disease and might also influence the clinical spectrum of the disease. Increased awareness and up-gradation of socioeconomic status might ameliorate the prevalence of rheumatic heart disease.

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Abstract 14693: Rheumatic Heart Disease and Deprivation in the United States: A Retrospective Review

Circulation ◽

10.1161/circ.142.suppl_3.14693 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Sarah R De Loizaga ◽

Lindsay Arthur ◽

Bhawna Arya ◽

Andrew F Beck ◽

Brian Beckman ◽

...

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

Cardiovascular Health ◽

Pacific Islands ◽

Severe Disease ◽

The United States ◽

Standard Deviation Increase ◽

Increased Risk ◽

The Us ◽

Rheumatic Heart

Introduction: Rheumatic heart disease (RHD) tracks with other cardiovascular health inequities in the US; however, RHD mortality captures a fraction of those affected and lags behind diagnosis by decades. There is little contemporary data on children living with acute rheumatic fever (ARF) and RHD within the US. This study describes recent pediatric ARF/RHD in the US and examines the association with community deprivation. Methods: Sixty US institutions were invited to participate in a 10-year review (2008-2018). Geocoding was used to determine a census tract-based socioeconomic deprivation index (DI) ranging from 0-1 (1 being most deprived). Independent sample t-test was used to compare DI means. Odds ratios (OR) with 95% confidence intervals were obtained from multivariable logistic regression. The DI was scaled to provide ORs for a one standard deviation increase. Results: Data for 947 cases from 22 institutions showed median age at diagnosis of 9 years, with half identifying as male (51%) and non-white (52%), and three-quarters (74%) identifying as non-Hispanic. Most identified English as their primary language, had health insurance, and were first diagnosed in the US (84%, 89%, and 82%, respectively). Of the 157 (17%) with travel exposure, Pacific Islands (38%) and Africa (21%) were most commonly identified. Nearly three-quarters (73%) were diagnosed with ARF and most (98%) had an echocardiogram at diagnosis. While 96% of patients were prescribed secondary prophylaxis, only half (58%) were prescribed intramuscular Benzathine penicillin (BPG), the gold standard. The mean DI was 0.39±0.15. Higher deprivation was associated with RHD as opposed to ARF at diagnosis (DI 0.42 vs. 0.38, p<0.001). Additionally, higher deprivation was associated with increased risk of severe RHD (OR 1.34; 95% CI 1.11-1.62) and increased use of BPG vs enteral penicillin for secondary prevention (OR 0.67; 95% CI 0.56-0.8). Conclusions: Recent pediatric cases of ARF and RHD in the US are endemic, rather than from foreign exposure and children who live in more deprived communities are at risk for more severe disease. Additional research is needed into why intramuscular penicillin, which has superior efficacy compared to oral penicillin, is prescribed in only half of cases.

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