The Global Burden of Rheumatic Heart Disease: Population-Related Differences (It is Not All the Same!)

Abstract

Rheumatic heart disease (RHD) remains the most common cardiovascular disease in young adults and adolescents in need of heart surgery in low- and middle-income countries (LMICs). The mean age of patients is 20-25 years, often much younger. By contrast, the few patients with chronic RHD in developed countries present a mean age of around 55 years. It is absolutely fundamental to differentiate these two types of population. Pathology, lesions and surgical methods are different, and the results should not be compared. It is not all the same! A certain enthusiasm for mitral repair has recently surged, with several reports showing excellent results in children and young adults, resulting from the renewed interest of cardiac surgeons, also based on new and modified techniques developed in the meantime. While surgery is easily accessible to patients in developed countries, the situation in LMICs is often dramatic, with countries where there is a complete absence of or few surgical facilities absolutely unable to meet gigantic demands. Many foreign surgical teams conduct humanitarian missions in several of these countries. They are just a “drop of water in the ocean” of needs. In some cases, however, these missions led to the establishment of local teams that now work independently and, in some cases, outperform the foreign teams still visiting.

Demographic Profile and Clinical History of Newly Diagnosed Mitral Stenosis Patients

“…The contribution of rheumatic heart diseases to the premature death rate is still significant in underdeveloped and developing countries as a result of poverty and household overcrowding. 1,7 It is one of the neglected and most underdiagnosed disease in our part of the world, therefore, regional as well as local data are lacking. Therefore, in this study we aimed to explore the demographic profile and clinical characteristics of newly diagnosed MS patients in our population.…”

“…Acute RF is still an important cause with significant contribution to the premature death in our part of the world. 1 Children of age 5 to 14 years are at increased risk of ARF, but recurrent episodes can be commonly observed in adults up to the age of 40 years. It is a neglected disease entity which mostly remained underdiagnosed, therefore, its true prevalence and incidence is unknown.…”

“…It is a neglected disease entity which mostly remained underdiagnosed, therefore, its true prevalence and incidence is unknown. 1 Mitral regurgitation (MR), valvulitis, and pancarditis are the commonly observed valvular abnormalities in the early stage of diseases. 2 From the second decade of life mixed aortic and mitral valve diseases start emerging and rheumatic mitral stenosis (MS) increases in prevalence.…”

Rheumatic heart disease: The role of global cardiac surgery

“…However, ultimately, it must be emphasized that prevention and eradication of RHD remains the primary goal. The cost of RHD valve surgery ranges between US$10,000–25,000 in LMICs, which is the same amount of money needed to fund one full year of an RHD screening program 30 . This is further illustrated by the favorable cost‐effectiveness of RHD screening among socioeconomically disadvantaged children 31,32 …”

Clinical Profile of Patients with Atrial Fibrillation According to EHRA (Evaluated Heart Valves, Rheumatic or Artificial) Categorization in A Middle-Income Country

“…In some countries, there is a decrease in new cases, but with a predominance of chronic presentation of this rheumatic valve disease. Due to the difficulty in accessing medical care in some regions and poor adherence to prevention, there is an unfavorable impact on the clinical evolution and surgical outcomes of these patients [6].…”