Rheumatic Heart Disease in Pregnancy

Mocumbi, Ana Olga; Beaton, Andrea; Soma-Pillay, Priya; Dougherty, Scott; Sliwa, Karen

doi:10.1016/b978-0-323-63982-8.00009-x

Cited by 3 publications

(5 citation statements)

References 83 publications

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“…Pregnancy is a health state during which higher risk of complication or death from RHD can occur. 32 Although we do not explicitly model the state of pregnancy, our model covers this population through management of severe disease generally. Increasing coverage of family planning services might have a larger population impact, mitigating RHD-related complications during pregnancy.…”

Section: Methodsmentioning

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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Section: Methodsmentioning

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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“…Much of the work on the impact of RHD in pregnancy that has informed subsequent research and guided policy has been conducted in sub-Saharan Africa [ 17 18 19 20 21 52 58 59 60 61 ]. More recent studies from Uganda in particular call for improved family/societal education programs and community engagement, leading to better outcomes and patient empowerment [ 62 63 ].…”

Section: Discussionmentioning

confidence: 99%

“…The last decade has seen a groundswell of research and advocacy positioning RHD in the global health arena [ 8 9 10 11 12 13 14 ]. Against this backdrop, particular challenges of providing optimal care for women with RHD-P are increasingly evident [ 3 15 16 17 18 19 20 21 22 ].…”

Section: Introductionmentioning

confidence: 99%

Caring for Pregnant Women with Rheumatic Heart Disease: A Qualitative Study of Health Service Provider Perspectives

Vaughan

Dawson

Peek

et al. 2021

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Background: Rheumatic heart disease (RHD) persists in low-middle-income countries and in high-income countries where there are health inequities. RHD in pregnancy (RHD-P) is associated with poorer maternal and perinatal outcomes. Our study examines models of care for women with RHD-P from the perspectives of health care providers. Methods: A descriptive qualitative study exploring Australian health professionals' perspectives of care pathways for women with RHD-P. Thematic analysis of semi-structured interviews with nineteen participants from maternal health and other clinical and non-clinical domains related to RHD-P. Results: A constellation of factors challenged the provision of integrated women-centred care, related to health systems, workforces and culture. Themes that impacted on the provision of quality woman-centred care included conduits of care -helping to break down silos of information, processes and access; 'layers on layers' -reflecting the complexity of care issues; and shared understandings -factors that contributed to improved understandings of disease and informed decision-making. Conclusions: Pregnancy for women with RHD provides an opportunity to strengthen health system responses, improve care pathways and address whole-of-life health. To respond effectively, structural and cultural changes are required including enhanced investment in education and capacity building -particularly in maternal health -to support a better informed and skilled workforce. Aboriginal Mothers and Babies programs provide useful exemplars to guide respectful effective models of care for women with RHD, with relevance for non-Indigenous women in high-risk RHD communities.For key goals to be met in the context of RHD, maternal health must be better integrated into RHD strategies and RHD better addressed in maternal health.

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“…State‐of‐the‐art artificial heart valves have limitations which influence their use in emerging markets and developing economies. Mechanical heart valves have good durability but require lifelong anti‐coagulation or antiplatelet therapy to avoid thrombo‐embolic complications 12,13 . This is expensive, increases the risk of severe bleeding and is often unavailable to patients in the emerging economies.…”

Section: Introductionmentioning

confidence: 99%

“…Mechanical heart valves have good durability but require lifelong anti-coagulation or antiplatelet therapy to avoid thrombo-embolic complications. 12,13 This is expensive, increases the risk of severe bleeding and is often unavailable to patients in the emerging economies. Bioprosthetic valves, formed either through sheets of the pericardium or explanted from porcine hearts, do not require anti-coagulation therapy.…”

mentioning

confidence: 99%

Three‐dimensional fluid–structure interaction simulation of the Wheatley aortic valve

Oliveira,

Buscaglia,

Paz

et al. 2023

Numer Methods Biomed Eng

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Valvular heart diseases (such as stenosis and regurgitation) are recognized as a rapidly growing cause of global deaths and major contributors to disability. The most effective treatment for these pathologies is the replacement of the natural valve with a prosthetic one. Our work considers an innovative design for prosthetic aortic valves that combines the reliability and durability of artificial valves with the flexibility of tissue valves. It consists of a rigid support and three polymer leaflets which can be cut from an extruded flat sheet, and is referred to hereafter as the Wheatley aortic valve (WAV). As a first step towards the understanding of the mechanical behavior of the WAV, we report here on the implementation of a numerical model built with the ICFD multi‐physics solver of the LS‐DYNA software. The model is calibrated and validated using data from a basic pulsatile‐flow experiment in a water‐filled straight tube. Sensitivity to model parameters (contact parameters, mesh size, etc.) and to design parameters (height, material constants) is studied. The numerical data allow us to describe the leaflet motion and the liquid flow in great detail, and to investigate the possible failure modes in cases of unfavorable operational conditions (in particular, if the leaflet height is inadequate). In future work the numerical model developed here will be used to assess the thrombogenic properties of the valve under physiological conditions.

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Rheumatic Heart Disease in Pregnancy

Cited by 3 publications

References 83 publications

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

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

Caring for Pregnant Women with Rheumatic Heart Disease: A Qualitative Study of Health Service Provider Perspectives

Three‐dimensional fluid–structure interaction simulation of the Wheatley aortic valve

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