Measuring and reporting disease progression in subclinical rheumatic heart disease: Table 1

Karthikeyan, Ganesan

doi:10.1136/heartasia-2016-010857

Cited by 12 publications

(7 citation statements)

References 10 publications

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“…As more data emerges on the natural history of latent RHD, it is important to consider standardized reporting of outcomes 36 . The 2012 WHF criteria represent the best available evidence for the echocardiographic diagnosis and classification of latent RHD, and have been widely adopted facilitating reproducible diagnostic categories 9 .…”

Section: Discussionmentioning

confidence: 99%

“…Here, as reported by several recent studies 24, 25 , we use an expanded definition of change including but not limited to change in WHF category. Expert agreement on these definitions would facilitate better comparison across populations, but until this agreement, clear reporting of definitions and provision of granular details on reasons for change is essential 36 . Grouping of disease trajectory into clinically meaningful outcomes is also important.…”

Section: Discussionmentioning

confidence: 99%

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Latent Rheumatic Heart Disease

et al. 2017

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Background Screening echocardiography (echo) has emerged as a potentially powerful tool for early diagnosis of rheumatic heart disease (RHD). The utility of screening echo hinges on the rate of RHD progression and the ability of penicillin prophylaxis to improve outcome. We report the longitudinal outcomes of a cohort of children with latent RHD and identify risk factors for unfavorable outcomes. Methods This was a prospective natural history study conducted under the Ugandan RHD registry. Children with latent RHD and ≥1 year of follow-up were included. All echos were re-reviewed by experts (2012 WHF criteria) for inclusion and evidence of change. Bi- and multi- variable logistic regression, Kaplan-Meier analysis, as well as Cox proportional hazard models were developed to search for risk factors for unfavorable outcome and compare progression-free survival between those treated and not treated with penicillin. Propensity and other matching methods with sensitivity analysis were implemented for the evaluation of the penicillin effect. Results Blinded review confirmed 227 cases of latent RHD: 164 borderline and 63 definite (42 mild, 21 moderate/severe). Median age at diagnosis was 12 years and median follow-up was 2.3 years (IQR 2.0–2.9). Penicillin prophylaxis was prescribed in 49.3% with overall adherence of 84.7%. Of children with moderate/severe definite RHD, 47.6% had echo progression (including 2 deaths), and 9.5% echo regression. Children with mild definite and borderline RHD showed 26% and 9.8% echo progression and 45.2% and 46.3% echo improvement respectively. Of those with mild definite RHD or borderline RHD, more advanced disease category, younger age, and morphological mitral valve features were risk factors for an unfavorable outcome. Conclusions Latent RHD is a heterogeneous diagnosis with variable disease outcomes. Children with moderate to severe latent RHD have poor outcomes. Children with both borderline and mild definite RHD are at substantial risk of progression. While long-term outcome remains unclear, the initial change in latent RHD may be evident during the first 1–2 years following diagnosis. Natural history data is inherently limited and a randomized clinical trial is needed to definitively determine the impact of penicillin prophylaxis on the trajectory of latent RHD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Latent Rheumatic Heart Disease

et al. 2017

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“…Projections to 2090 should be interpreted with caution (appendix pp [38][39][40]55). Country-level and regional variation in epidemiology, demography, and economic productivity affects the estimated benefit-cost ratios (appendix pp [45][46]56). Additional results for the various described scenarios are presented in the appendix (pp 47-56).…”

Section: Role Of the Funding Sourcementioning

confidence: 99%

An investment case for the prevention and management of rheumatic heart disease in the African Union 2021–30: a modelling study

Coates

Sliwa

Watkins

et al. 2021

The Lancet Global Health

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Background Despite declines in deaths from rheumatic heart disease (RHD) in Africa over the past 30 years, it remains a major cause of cardiovascular morbidity and mortality on the continent. We present an investment case for interventions to prevent and manage RHD in the African Union (AU).Methods We created a cohort state-transition model to estimate key outcomes in the disease process, including cases of pharyngitis from group A streptococcus, episodes of acute rheumatic fever (ARF), cases of RHD, heart failure, and deaths. With this model, we estimated the impact of scaling up interventions using estimates of effect sizes from published studies. We estimated the cost to scale up coverage of interventions and summarised the benefits by monetising health gains estimated in the model using a full income approach. Costs and benefits were compared using the benefit-cost ratio and the net benefits with discounted costs and benefits.Findings Operationally achievable levels of scale-up of interventions along the disease spectrum, including primary prevention, secondary prevention, platforms for management of heart failure, and heart valve surgery could avert 74 000 (UI 50 000-104 000) deaths from RHD and ARF from 2021 to 2030 in the AU, reaching a 30•7% (21•6-39•0) reduction in the age-standardised death rate from RHD in 2030, compared with no increase in coverage of interventions. The estimated benefit-cost ratio for plausible scale-up of secondary prevention and secondary and tertiary care interventions was 4•7 (2•9-6•3) with a net benefit of $2•8 billion (1•6-3•9; 2019 US$) through 2030. The estimated benefit-cost ratio for primary prevention scale-up was low to 2030 (0•2, <0•1-0•4), increasing with delayed benefits accrued to 2090. The benefit-cost dynamics of primary prevention were sensitive to the costs of different delivery approaches, uncertain epidemiological parameters regarding group A streptococcal pharyngitis and ARF, assumptions about long-term demographic and economic trends, and discounting.Interpretation Increased coverage of interventions to control and manage RHD could accelerate progress towards eradication in AU member states. Gaps in local epidemiological data and particular components of the disease process create uncertainty around the level of benefits. In the short term, costs of secondary prevention and secondary and tertiary care for RHD are lower than for primary prevention, and benefits accrue earlier.

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“…Previous studies on the natural history of latent RHD have reported progression of valve lesions in a relatively short follow-up period 34 . However, studies utilizing echocardiography have employed different definitions of progression, and standardization is required in reporting outcomes 35 . Although most children with borderline or mild definite RHD remain stable or demonstrate improvement, they are at substantial risk of progression 34 .…”

Section: Subclinical Disease Detected By Screening Echocardiographymentioning

confidence: 99%

Rheumatic heart disease in the modern era: recent developments and current challenges

Leal

Passos

Guarçoni

et al. 2019

Rev. Soc. Bras. Med. Trop.

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Rheumatic heart disease (RHD) remains a major cause of preventable death and disability in children and young adults. Despite significant advances in medical technology and increased understanding of disease mechanisms, RHD continues to be a serious public health problem throughout the world, especially in low-and middle-income countries. Echocardiographic screening has played a key role in improving the accuracy of diagnosing RHD and has highlighted the disease burden. Most affected patients present with severe valve disease and limited access to life-saving cardiac surgery or percutaneous valve intervention, contributing to increased mortality and other complications. Although understanding of disease pathogenesis has advanced in recent years, key questions remain to be addressed. Preventing or providing early treatment for streptococcal infections is the most important step in reducing the burden of this disease.

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Measuring and reporting disease progression in subclinical rheumatic heart disease: Table 1

Cited by 12 publications

References 10 publications

Latent Rheumatic Heart Disease

Latent Rheumatic Heart Disease

An investment case for the prevention and management of rheumatic heart disease in the African Union 2021–30: a modelling study

Rheumatic heart disease in the modern era: recent developments and current challenges

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