225 Rheumatic heart disease in Timor Leste school students (RHD-TL) follow-up study: assessment of secondary prophylaxis and outcomes in Timor Leste

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
A Horton ◽  
B Remenyi ◽  
K Davis ◽  
N Mock ◽  
E Paratz ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Secondary Prophylaxis ◽  
Penicillin G ◽  
School Students ◽  
Borderline Cases ◽  
Follow Up Study ◽  
Timor Leste ◽  
Rheumatic Heart

Abstract Background The Rheumatic Heart disease in Timor Leste school students (RHD-TL) study identified Timor Leste as having some of the highest rates of definite rheumatic heart disease (RHD) in the world. The RHD-TL follow-up study aimed to assess the delivery and outcomes of the secondary prophylaxis program in known patients with echocardiographic screen detected definite and borderline RHD. Methods School-students in Timor Leste where reassessed over a 3-year period since the initial study in 2016. Prospective assessments included adherence to secondary prophylaxis, complications of prophylaxis, follow-up clinical assessment and serial echocardiography. Of the 48 patients, 25 Definite and 23 Borderline, 38 (79%) of all patients, and 92% of definite RHD cases have had one or more follow-up assessments including full datasets for adherence, recurrence rates and progression of disease. Follow-up is provided by the volunteer paediatric cardiology team and rheumatic heart disease team of two NGOs in collaboration with local clinics. Results The median duration of follow-up of the 38 patients was of 1.6 years. The median age was 13 years (range 8-22) and 75% were female. Adherence rates in patients with definite RHD was on average greater than 95% during the follow-up period. Of the 23 patients with mild or moderate RHD one case with documented acute rheumatic fever (ARF) recurrence progressed whilst 8 cases improved on benzathine-penicillin G (BPG) therapy. There was no progression of the 6 borderline cases who were not prescribed BPG. Out of the 9 borderline cases in whom BPG was prescribed, one, with 67% adherence, had a documented episode of ARF leading to echocardiographic progression and moderate definite RHD. Conclusion This was the first follow-up study to look at disease natural history, both in treated and untreated groups, in Timor-Leste and brought practical insights into the efficacy of the Timor Leste RHD monitoring and prophylaxis programs. Its ongoing project will enable advocacy and quality assessment for the program as it expands. Abstract 225 Figure 1.

Rheumatic heart disease in Timor‐Leste school students: an echocardiography‐based prevalence study

2018 ◽  
Vol 208 (7) ◽  
pp. 303-307 ◽  
Author(s):  
Kimberly Davis ◽  
Bo Remenyi ◽  
Anthony DK Draper ◽  
Januario Dos Santos ◽  
Noel Bayley ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Prevalence Study ◽  
School Students ◽  
Timor Leste ◽  
Rheumatic Heart

scholarly journals Mid-term outcome of children with latent rheumatic heart disease in eastern Nepal

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001605
Author(s):  
Nikesh Raj Shrestha ◽  
Dorothea Bruelisauer ◽  
Surendra Uranw ◽  
Rajan Mahato ◽  
Kunjang Sherpa ◽  
...  
Keyword(s):  
Heart Disease ◽  
Antibiotic Prophylaxis ◽  
Rheumatic Heart Disease ◽  
Univariate Analysis ◽  
Secondary Prophylaxis ◽  
Term Outcome ◽  
Registration Number ◽  
Lost To Follow Up ◽  
Rheumatic Heart

IntroductionSystematic echocardiographic screening of children in regions with an endemic pattern of rheumatic heart disease allows for the early detection of valvular lesions suggestive of subclinical rheumatic heart disease. The natural course of latent rheumatic heart disease is, however, incompletely understood at this time.MethodsWe performed a prospective cohort study of children detected to have echocardiographic evidence of definite or borderline rheumatic heart disease according to the World Heart Federation Criteria.ResultsAmong 53 children found to have definite (36) or borderline (17) rheumatic heart disease, 44 (83%) children underwent follow-up at a median of 1.9 years (IQR 1.1–4.5). The median age of the children was 11 years (IQR 9–14) and 34 (64.2%) were girls. Among children with definite rheumatic heart disease, 21 (58.3%) were adherent to secondary antibiotic prophylaxis, 7 (19.4%) were not, information on adherence was missing in 2 (5.6%) children and 6 (16.7%) were lost to follow-up. Regression of disease was observed in 10 children (27.8%), whereas 20 children (55.6%) had stable disease. Among children adherent to secondary prophylaxis, seven (33.3%) showed regression of disease. Among children with borderline disease, seven (41.2%) showed regression of disease, three (17.6%) progression of disease, four (23.5%) remained stable and three (17.6%) were lost to follow-up. On univariate analysis, we identified no predictors of disease regression, and no predictors for lost to follow-up or non-adherence with secondary antibiotic prophylaxis.ConclusionDefinite rheumatic heart disease showed regression in one in four children. Borderline disease was spontaneously reversible in less than half of the children and progressed to definite rheumatic heart disease in one in five children.Trial registration numberNCT01550068.

scholarly journals Follow up study of rheumatic heart disease.

1981 ◽  
Vol 45 (12) ◽  
pp. 1426-1429
Author(s):  
MITSUO KITADA ◽  
SETSUKO NAKAJIMA ◽  
KINICHI UHEDA ◽  
KENJI YASUTAKE ◽  
TADASHI NAKAGAWA
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Follow Up Study ◽  
Rheumatic Heart

scholarly journals Outcomes of Echocardiography‐Detected Rheumatic Heart Disease: Validating a Simplified Score in Cohorts From Different Countries

2021 ◽  
Vol 10 (18) ◽  
Author(s):  
Bruno R. Nascimento ◽  
Maria Carmo P. Nunes ◽  
Emily M. Lima ◽  
Amy E. Sanyahumbi ◽  
Nigel Wilson ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Diagnostic Category ◽  
Secondary Prophylaxis ◽  
Interquartile Range ◽  
Unfavorable Outcome ◽  
Score Model ◽  
External Population ◽  
Rheumatic Heart

Background The natural history of latent rheumatic heart disease (RHD) detected by echocardiography remains unclear. We aimed to assess the accuracy of a simplified score based on the 2012 World Heart Federation criteria in predicting mid‐term RHD echocardiography outcomes in children from 4 different countries. Methods and Results Patient‐level baseline and follow‐up data of children with latent RHD from 4 countries (Australia, n=62; Brazil, n=197; Malawi, n=40; New Zealand, n=94) were combined. A simplified echocardiographic scoring system previously developed from Brazilian and Ugandan cohorts, consisting of 5 point‐based variables with respective weights, was applied: mitral valveanterior leaflet thickening (weight=3), excessive leaflet
tip motion (3), regurgitation jet length ≥2 cm (6), aortic valve
focal thickening (4), and any regurgitation (5). Unfavorable outcome was defined as worsening diagnostic category, persistent definite RHD or development/worsening of valve regurgitation/stenosis. The score model was updated using methods for recalibration. 393 patients (314 borderline, 79 definite RHD) with median follow‐up of 36 (interquartile range, 25–48) months were included. Median age was 14 (interquartile range, 11–16) years and secondary prophylaxis was prescribed to 16%. The echocardiographic score model applied to this external population showed significant association with unfavorable outcome (hazard ratio, 1.10; 95% CI, 1.04–1.16; P =0.001). Unfavorable outcome rates in low (≤5 points), intermediate (6–9), and high‐risk (≥10) children at 3‐year follow‐up were 14.3%, 20.8%, and 38.5% respectively ( P <0.001). The updated score model showed good performance in predicting unfavorable outcome. Conclusions The echocardiographic score model for predicting RHD outcome was updated and validated for different latent RHD populations. It has potential utility in the clinical and screening setting for risk stratification of latent RHD.

scholarly journals Rheumatic Heart Disease in the United States: Forgotten But Not Gone

2021 ◽  
Author(s):  
Sarah R. de Loizaga ◽  
Lindsay Arthur ◽  
Bhawna Arya ◽  
Brian Beckman ◽  
Wubishet Belay ◽  
...  
Keyword(s):  
United States ◽  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Disease Severity ◽  
Severe Disease ◽  
The United States ◽  
Secondary Prophylaxis ◽  
Penicillin G ◽  
Endemic Region ◽  
Rheumatic Heart

Background Recent evaluation of rheumatic heart disease (RHD) mortality demonstrates disproportionate disease burden within the United States. However, there are few contemporary data on US children living with acute rheumatic fever (ARF) and RHD. Methods and Results Twenty‐two US pediatric institutions participated in a 10‐year review (2008–2018) of electronic medical records and echocardiographic databases of children 4 to 17 years diagnosed with ARF/RHD to determine demographics, diagnosis, and management. Geocoding was used to determine a census tract‐based socioeconomic deprivation index. Descriptive statistics of patient characteristics and regression analysis of RHD classification, disease severity, and initial antibiotic prescription according to community deprivation were obtained. Data for 947 cases showed median age at diagnosis of 9 years; 51% and 56% identified as male and non‐White, respectively. Most (89%) had health insurance and were first diagnosed in the United States (82%). Only 13% reported travel to an endemic region before diagnosis. Although 96% of patients were prescribed secondary prophylaxis, only 58% were prescribed intramuscular benzathine penicillin G. Higher deprivation was associated with increasing disease severity (odds ratio, 1.25; 95% CI, 1.08–1.46). Conclusions The majority of recent US cases of ARF and RHD are endemic rather than the result of foreign exposure. Children who live in more deprived communities are at risk for more severe disease. This study demonstrates a need to improve guideline‐based treatment for ARF/RHD with respect to secondary prophylaxis and to increase research efforts to better understand ARF and RHD in the United States.

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