Current Situation of Acute Rheumatic Fever and Rheumatic Heart Disease in Latin America and the Caribbean: A Systematic Review

Abstract

Background: Rheumatic heart disease (RHD) disproportionately affects low-income and middle-income countries. Latin America and the Caribbean (LAC) have been less represented in scientific literature. We aimed to describe the epidemiology, burden and implemented screening and prevention strategies of RHD in LAC. Methods:We systematically searched PubMed, Embase, LILACS, and SciELO from 1990 to April 2021. Observational and experimental studies that described data on the epidemiology, burden, or prevention/screening strategies of RHD, regardless of age or language, were included. The risk of bias was assessed by previously published tools depending on their study design. Pre-specified data were independently extracted and presented by each topic (epidemiology, burden, prevention/screening). PROSPERO registration number: CRD42021250043. Results:Forty-eight studies out of 1692 non-duplicate records met the eligibility criteria. They were mainly from Brazil, observational in design, and hospital-based. Data on the epidemiology of acute rheumatic fever (ARF) was not recent (most before 2000) with studies describing decreasing incidence through the years. The prevalence of RHD was described in six studies, ranging from 0.24 to 48 per 1,000 among studies evaluating schoolchildren. Nine studies described data based on admissions, ranging from 0.04% to 7.1% in single-center studies. Twenty-four studies assessed the burden of RHD with most of them reporting mortality rates/proportions and complications such as the need for intervention, atrial fibrillation, or embolism. Six preventive strategies were identified that included educational, register-based, and/or secondary prophylaxis strategies. Three well-established echocardiographic screening studies in Brazil and Peru were identified. Conclusions:Most ARF/RHD research in LAC comes from a single country, Brazil where preventive/screening efforts have been conducted. There was a paucity of data from several countries in the region, reflecting the need for epidemiological studies from more countries in LAC which will provide a better picture of the current situation of ARF/RHD and guide the implementation of preventive strategies. 2 Jaimes-Reyes et al.

The role of echocardiographic screening in reducing the burden of rheumatic heart disease in Latin America

“…In our recent systematic review, we summarized data from primary studies on RHD in this region. One of the main findings was the varying prevalence reported, with studies that assessed schoolchildren describing rates of between 0.24 and 48 per 1 000 ( 7 ). Furthermore, in a secondary analysis of data from the Global Burden of Disease study, Ordunez et al identified an age-standardized prevalence of 532.8 per 100 000 population in Latin America and the Caribbean in 2017 ( 10 ).…”

“…A few RHD studies based on echocardiographic diagnosis have been published in Latin America ( 7 ), with the most recent being the Programa de Rastreamento da Valvopatia Reumática (PROVAR) study in Brazil ( 20 ). This is the first large-scale screening program for RHD in South America and is based on a collaboration between researchers from Brazil and the United States ( 20 ).…”

“…Fourth, identifying areas where implementation of screening programs should be prioritized will also be important ( 25 ). This issue prompts the recognition of other needs in Latin America – that is, the need for updated epidemiological data and registries ( 1 , 7 , 25 ).…”

“…Latin America still has marked socioeconomic inequalities that produce significant barriers to accessing health care ( 6 ). This may be why the epidemiology of RHD in Latin America is largely unknown ( 7 ). In this article, we briefly discuss the rationale for using echocardiographic screening to detect RHD and review studies, with the objective of proposing the key steps needed to successfully establish such screening programs in Latin America.…”

Preventive Interventions to Reduce the Burden of Rheumatic Heart Disease in Populations at Risk: A Systematic Review

“…With the new interest and resolutions, various preventive interventions have been implemented in various settings, including community‐based outreach programs, school‐based programs, and screening‐based interventions, including the expansion of penicillin prophylaxis and surveillance. 14 , 15 , 16 However, there is a paucity of evidence regarding the effectiveness of these recent interventions added to the interventions in the 1980s and 1990s. It is important to synthesize as much current evidence as possible to determine the effectiveness of these interventions to provide guidance for policy and practice and also highlight the work that has been done in the 21st century so far in response to the new resolutions.…”