Community study to uncover the full spectrum of rheumatic heart disease in Uganda

Background: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). Methods: The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year’s worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year’s edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. Results: Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. Conclusions: The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

show abstract

“…In a study from Uganda, the prevalence of rheumatic HD in adults >20 years of age was 2.34% (95% CI, 1.49%–3.49%). 103…”

Section: Valvular Diseasesmentioning

confidence: 99%

Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association

Tsao¹,

Aday²,

Almarzooq³

et al. 2022

Circulation

3,810

2,336

View full text Add to dashboard Cite

show abstract

“…Through echocardiographic screening, prior studies have demonstrated high prevalence rates of RHD, 2.5%–3% in the general population in Uganda 5–7. A country-wide RHD registry was developed in Uganda in 2010 to improve the care and follow-up of children and adults with RHD 8.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of children with rheumatic heart disease

Zimmerman

Kitooleko

Okello

et al. 2022

Heart

Self Cite

View full text Add to dashboard Cite

ObjectiveTo evaluate the long-term clinical outcomes of children with rheumatic heart disease (RHD) in Uganda, and determine characteristics that predict adverse outcomes.MethodsThis retrospective cohort study evaluated the risk of death in Ugandan children with clinical RHD from 2010 to 2018; enrolling children aged 5–18 years old from an existing registry. Demographic data and clinical data (baseline complications, RHD severity, cardiac interventions) were collected. The primary outcome was survival. Univariable and multivariable hazard ratios (HR) were obtained from Cox proportional hazards regression. Survival probabilities were developed using Kaplan-Meier curves; log-rank tests compared survival based on cardiac interventions, disease severity and time of enrolment.Results612 cases met inclusion criteria; median age 12.8 years (IQR 5.3), 37% were male. Thirty-one per cent (187 of 612) died during the study period; median time to death 7.8 months (IQR 18.3). In univariable analysis, older age (HR 1.26, 95% CI=1.0 to 1.58), presence of baseline complications (HR 2.06, 95% CI=1.53 to 2.78) and severe RHD (HR 5.21, 95% CI=2.15 to 12.65) were associated with mortality. Cardiac intervention was associated with a lower risk of mortality (HR 0.06, 95% CI=0.02 to 0.24). In multivariable models, baseline complications (HR 1.78, 95% CI=1.31 to 2.41), severe RHD (HR 4.58, 95% CI=1.87 to 11.23) and having an intervention (HR 0.05, 95% CI=0.01 to 0.21) remained statistically significant. Kaplan-Meier survival curves demonstrated >25% mortality in the first 30 months, with significant differences in mortality based on intervention status and severity of disease.ConclusionsThe mortality rate of children with clinical RHD in Uganda exceeds 30%, over an 8-year time frame, despite in-country access to cardiac interventions. Children at highest risk were those with cardiac complications at baseline and severe RHD.

show abstract

“…The overall prevalence of RHD in children screened in this study was only 1%, which was lower than anticipated. Previous screening studies in this region have shown a prevalence of 2.5-3% (13,17,18). While this study was not designed to understand this difference, it is possible that multiple prior echo screening studies, which included RHD education in schools, health centers, and in the community, may have increased awareness and subsequently reduced community rates of new RHD through improved primary and secondary prevention.…”

Section: Discussionmentioning

confidence: 93%

Determining the Risk of Developing Rheumatic Heart Disease Following a Negative Screening Echocardiogram

Zimmerman

Scheel

DeWyer

et al. 2021

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

Background: Screening echocardiograms can detect early-stage rheumatic heart disease (RHD), offering a chance to limit progression. Implementation of screening programs is challenging and requires further research. This is the first large-scale study assessing the risk of RHD among previous screen-negative children.Methods: This retrospective cohort study, conducted in Gulu, Uganda, performed school-based echo screening on children ages 5–18 years. Surveys were used to determine which children underwent initial screening 3–5 years prior. Age, gender, and disease severity were compared between cohorts. Relative risk (RR) of RHD was calculated for those with a prior screen-negative echo (exposed cohort) compared to those undergoing first screening (unexposed cohort).Results: Echo screening was completed in 75,708 children; 226 were excluded, leaving 1,582 in the exposed cohort and 73,900 in the unexposed cohort. Prevalence of new RHD was 0.6% (10/1,582) and 1% (737/73,900), in the exposed and unexposed cohorts, respectively. The RR of RHD was 0.64 (95% CI 0.3–1.2, p = 0.15), a nearly 40% reduced risk of RHD in those with a prior negative echo. There was no difference in age or gender between RHD cohorts. All cases in the exposed cohort were borderline/mild; 2.6% of cases in the unexposed cohort had moderate/severe disease.Conclusion: There was no statistical difference in RHD prevalence between previous screen-negative children and children with no prior echocardiogram, however, there was a trend toward decreased risk and severity. This information has important implications for the design of screening programs and the use of screening echocardiograms in endemic RHD regions.

show abstract

Community study to uncover the full spectrum of rheumatic heart disease in Uganda

Abstract: Our data reveal a high prevalence of undiagnosed RHD within an endemic community and fill a critical gap in RHD epidemiology in African adults.

Cited by 27 publications

References 20 publications

Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association

Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association

Clinical outcomes of children with rheumatic heart disease

Determining the Risk of Developing Rheumatic Heart Disease Following a Negative Screening Echocardiogram

Contact Info

Product

Resources

About