Secondary prevention for screening detected rheumatic heart disease: opportunities to improve adherence

Engelman, Daniel; Kee, Maureen Ah; Mataika, Reapi L.; Kado, Joseph; Colquhoun, Samantha; Tulloch, Jim; Steer, Andrew C.

doi:10.1093/trstmh/trx035

Cited by 9 publications

(11 citation statements)

References 25 publications

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“…A very low overall adherence of 6% was also reported in the South Pacific nation. 23 Furthermore, different studies reported reasons for poor adherence were lack of money, far distance from hospital, fear of medication side effects and painful injection, lack of awareness of the importance of BPG, and non-availability of BPG. 15,24,25 On the contrary, the adherence rate of the present study (80.6%) was less than that of Indian and New Zealand studies which reported (89.6%) 26 and (92%) 27 respectively.…”

Section: Discussionmentioning

confidence: 99%

“…13 Besides this, a study in Fiji reported lack of awareness, feeling well, access and transport cost as determinants of missing of BPG doses by recommending reminder strategies, particularly phone-based reminders which were considered helpful by 94% of participants to improve adherence. 23 Patients shall be advised about the importance of monthly BPG injection and its adherence. Since there were no many alternative drugs for secondary prevention of ARF, the hospital should always avail BPG.…”

Section: Discussionmentioning

confidence: 99%

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<p>Adherence to Benzathine Penicillin G Secondary Prophylaxis and Its Determinants in Patients with Rheumatic Heart Disease at a Cardiac Center of an Ethiopian Tertiary Care Teaching Hospital</p>

Mekonen

Yismaw

Abiye

et al. 2020

PPA

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Purpose: Benzathine penicillin G (BPG) monthly administration is the most effective method for secondary prophylaxis against acute rheumatic fever (ARF). BPG's efficacy largely depends on adherence to treatment. This study was aimed at assessing adherence to BPG prophylaxis and its determinants among adult patients with rheumatic heart disease. Patients and Methods: An institutional cross-sectional study design was used. One hundred and forty-five patients receiving monthly BPG at the Adult Cardiac Clinic of Tikur Anbessa Specialized Hospital (TASH) were interviewed. Their 1-year BPG prophylaxis administration record was also reviewed. The rate of adherence to BPG injection was determined by calculating the percentage of the administered drug from the total expected doses. Data were entered and analyzed using Statistical Package for Social Sciences (SPSS) software version 25. Both descriptive and logistic regression analyses were computed to describe different variables and assess factors associated with adherence, respectively. A p-value <0.05 was used to declare association. Results: Among a total of 145 study participants involved, the majority (76.6%) of them had been receiving BPG for the last 10 years. The average adherence rate to monthly BPG injection was 80.60% with a range of 0% to 100%. However, only 101 (69.7%) of participants were taking ≥80% of their prescribed monthly BPG prophylaxis doses. Study participants with informal education 1.10 (0.023-46.96) and secondary school education 0.89 (0.10-8.11) were more and less likely to adhere to BPG injection, respectively, when compared with those who attended higher education programs. The regression analysis showed patients who were not admitted to the hospital (AOR: 26.22; CI: 2.55-269.70; p=0.006) and once admitted patients (AOR: 50.08; CI: 2.87-873.77; p=0.007) were more likely to adhere to their BPG injections than those admitted twice or more. The study participants who waited until the next appointment were also less adherent (AOR: 0.02; CI: 0.00-0.13; p=0.000) than those who went a few days later for receiving the missed/late dose. Conclusion: The adherence rate to BPG injection among RHD patients was found to be high (80.60%). Patients' admission status and their action on missed and/or late doses were found to be important determinants of adherence in this study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

<p>Adherence to Benzathine Penicillin G Secondary Prophylaxis and Its Determinants in Patients with Rheumatic Heart Disease at a Cardiac Center of an Ethiopian Tertiary Care Teaching Hospital</p>

Mekonen

Yismaw

Abiye

et al. 2020

PPA

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“…In New Zealand, dedicated RHD-nurses and engaged community health workers results in high adherence rates [25], an approach that has also resulted in highly adherent pediatric patients in some parts of Uganda [21]. Leveraging technology could also play a pivotal role, with young people in Fiji identifying mobile phone reminders as the most useful form of healthcare follow-up [26]. Ongoing work in Uganda through the American Heart Association's Strategically Focused Research Networks [27] to provide national data on the health-system response to RHD may provide additional interventions to improve adherence in this context.…”

Section: Discussionmentioning

confidence: 99%

The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study

Voleti¹,

Okello²,

Murali³

et al. 2020

BMC Pregnancy Childbirth

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Background Pre-existing maternal cardiac disease is a significant contributor to adverse maternal, fetal, and neonatal outcomes. In 2015–2017, our team conducted the first community-based study of maternal rheumatic heart disease (RHD) in sub-Saharan Africa and identified RHD in 88% of those with pre-existing heart disease. Here we conducted a follow up investigation of women previously identified with RHD, describing clinical and echocardiographic outcomes, identifying barriers to medical adherence and evaluating the personal impact of RHD. Methods A 2 week prospective follow up was completed at sites in Central and Eastern Uganda. Participants underwent a three-step mixed methods study comprising of 1) direct structured interview targeting clinical history and medication adherence, 2) echocardiogram to evaluate left-sided heart valves, and 3) semi-structured guideline interview to elicit personal impacts of RHD. Results The team evaluated 40 (80%) of the original 51 mothers with RHD at a median post-partum time of 2.5 years after delivery (IQR 0.5). Echocardiographic data showed improvement in nine women with the remaining 31 women showing stable echocardiographic findings. Adherence to Benzathine penicillin G (BPG) prophylaxis was poor, with 70% of patients either poorly adherent or non-adherent. Three major themes emerged from interviews: 1) social determinants of health (World Health Organization, Social determinants of health, 2019) negatively affecting healthcare, 2) RHD diagnosis negatively affecting female societal wellbeing, 3) central role of spouse in medical decision making. Conclusions Screening echocardiography can identify women with pre-existing rheumatic heart disease during pregnancy, but long-term follow-up in Uganda reveals adherence to medical care following diagnosis, including BPG, is poor. Additionally, mothers diagnosed with RHD may experience unintended consequences such as social stigmatization. As identification of occult RHD is critical to prevent adverse pregnancy outcomes, further research is needed to determine how to best support women who face a new diagnosis of RHD, and to determine the role of screening echocardiography in high-risk settings.

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“…There is an inevitable potential for systematic reviews to become outdated rapidly with the publication of new studies. Since the publication of the review by Kevat et al ., more than ten additional pertinent studies have been published, from Australia [ 11 - 13 ], Egypt [ 14 ], Fiji [ 15 , 16 ], India [ 17 ], Jamaica [ 18 ], New Zealand [ 19 , 20 ], Uganda [ 21 ] and Zambia [ 22 ].…”

Section: Commentmentioning

confidence: 99%

“…Firstly, the findings underscore that the determinants of effective SP implementation arise at the interface of health systems and the patient milieu. Examples of factors repeatedly identified as influencing adherence include geographic remoteness and physical distance to health facilities vis-à-vis transport options [ 15 , 18 , 23 , 24 ], inconvenience to patients exacerbated by competing priorities (such as schooling or employment) and clinic wait times [ 14 , 18 ], the quality of provider-patient relationships and communications [ 23 , 25 - 27 ], fear of painful injections [ 18 , 19 , 28 ], the degree of education and disease awareness among patients (or, in the case of children, their parents) [ 14 , 19 , 27 , 28 ], and levels of support from family and friends [ 24 , 25 ].…”

Section: Commentmentioning

confidence: 99%

Adherence to Secondary Prophylaxis Among Patients with Acute Rheumatic Fever and Rheumatic Heart Disease

Woods

Katzenellenbogen

2019

CCR

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Secondary prevention for screening detected rheumatic heart disease: opportunities to improve adherence

Abstract: We identified several factors influencing secondary prevention that may be used to develop interventions to improve adherence.

Cited by 9 publications

References 25 publications

<p>Adherence to Benzathine Penicillin G Secondary Prophylaxis and Its Determinants in Patients with Rheumatic Heart Disease at a Cardiac Center of an Ethiopian Tertiary Care Teaching Hospital</p>

<p>Adherence to Benzathine Penicillin G Secondary Prophylaxis and Its Determinants in Patients with Rheumatic Heart Disease at a Cardiac Center of an Ethiopian Tertiary Care Teaching Hospital</p>

The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study

Adherence to Secondary Prophylaxis Among Patients with Acute Rheumatic Fever and Rheumatic Heart Disease

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