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High rates for rheumatic heart disease persist in poorer areas
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The burden of rheumatic heart disease has decreased worldwide since 1990, but high rates persisted in poorer regions, according to a review published in The New England Journal of Medicine.
David A. Watkins, MD, MPH, physician-scientist in the department of medicine at University of Washington in Seattle and senior researcher at the Disease Control Priorities Network, and colleagues systematically reviewed data on worldwide rates of fatal and nonfatal rheumatic heart disease between 1990 and 2015.
Countries were categorized by the rheumatic heart disease patterns. Endemic patterns were seen in countries with high mortality rates and where the disease was prevalent among children. Nonendemic patterns were noted in countries with low rates of mortality, low prevalence in children and higher prevalence in older patients.
Disability-adjusted life-years were also calculated, which “allows us to highlight the countries that currently have the highest absolute and relative disease burden and that will require, relatively speaking, more resources to prevent and manage the disease,” Watkins said in an interview with Cardiology Today.
Researchers estimated that 319,400 deaths occurred in 2015 from rheumatic heart disease (95% uncertainty interval [UI], 297,300-337,300), which is an 8.1% decrease (95% UI, 2.7-13.5) from 1990 (347,500; 95% UI, 328,300-367,100).
From 1990 to 2015, global age-standardized mortality from rheumatic heart disease decreased by 47.8% (95% UI, 44.7-50.9). Mortality patterns varied significantly by world region in 2015, with the highest rates observed in South Asia, Oceania and central sub-Saharan Africa.
Countries with an endemic pattern of disease had 33,194,900 cases of rheumatic heart disease in 2015 (95% UI, 29,466,400-42,905,600) vs. 221,600 cases (95% UI, 205,800-238,300) in countries without an endemic pattern.
In 2015, the number of DALYs caused by rheumatic heart disease was 10,513,200 (95% UI, 9,611,000-11,514,500).
“Providing regular, usually monthly, preventive penicillin to individuals with a history of rheumatic fever or rheumatic heart disease is highly effective at preventing rheumatic fever recurrences and thus reducing the long-term severity of rheumatic heart disease,” Watkins said. “These interventions are relatively inexpensive and feasible in low-resource settings, but they are not currently being implemented at any scale. This is the first and biggest step toward reducing rheumatic heart disease rates in the poorest regions of the world.” – by Darlene Dobkowski
For more information:
David A. Watkins, MD, MPH, can be reached at davidaw@u.washington.edu.
Disclosures: Watkins reports receiving grants from the Medtronic Foundation. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Michael Seckeler, MD, MSc, FACC
The authors utilized a systematic and comprehensive review of all available data (vital statistics, published literature) in a series of mathematical models to provide the most up-to-date estimate of the burden of rheumatic heart disease around the world and compared it to the burden in 1990. In addition to the prevalence of rheumatic heart disease, they also provided estimates for morality related to rheumatic heart disease. Despite some decrease in the prevalence of rheumatic heart disease, it is still a disease with a heavy burden on the populations of the poorest countries (sub-Saharan Africa, South Asia and Oceania).
Education and primary prevention of group A strep pharyngitis, either with prompt antibiotic therapy or a successful vaccine, are still the best ways to decrease the occurrence of acute rheumatic fever, which can lead to rheumatic heart disease. Unfortunately, providing medical and surgical treatments for those people living with chronic rheumatic heart disease continues to heavily tax health care systems around the world.
Continuing the hard work that has been underway for many years to develop an effective group A strep vaccine will be an enormous step forward in eventually eradicating acute rheumatic fever and rheumatic heart disease.
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