A new study presented at the World Congress of Cardiology has shed light on the lack of effective treatment for patients with rheumatic heart disease (RHD) in the Middle East with researchers stating that they are being admitted too late to prevent heart surgery.
RHD is a devastating consequence of repeated episodes of rheumatic fever. The disease progresses over time and if it is not caught in the early stages, patients develop heart valve damage and will ultimately need surgery to replace the damaged valve(s).
A recent study in Yemen showed that 43 per cent (n=89/206) of patients admitted to hospital with RHD had rheumatic mitral stenosis - a narrowing of the opening of the heart's mitral value - and more than half were considered to have severe stenosis. Of those 87 patients followed, 53 per cent were recommended for percutaneous balloon mitral valvuloplasty (BMVP) - where the abnormally thickened mitral valve is dilated; a further 29 per cent were recommended for valve replacement surgery; while only 18 per cent were entered into a follow-up programme without interventional therapy of any kind.
"These results clearly demonstrate that RHD patients are seeking treatment from their doctors in the very late stages of their disease," said Dr. A. Sharafaddeen, Algomori Hospital, Taiz, Yemen. "But the management of these patients is costly. This money could be rather used much more efficiently in preventing and screening for the disease in its early stages."
Indeed, coordinated screening and control programmes to prevent progression to severe RHD can be carried out relatively cheaply.
"RHD can be prevented easily using penicillin - a cheap and readily available treatment," said Dr. Fahad Baslaib, President, Emirates Cardiac Society. "The funding required is minimal and control could be achieved by re-prioritizing existing budgets. We therefore have to consider implementing screening programmes in this region as a matter of urgency."
RHD in the Middle East
There is a lack of up-to-date information about the prevalence of RHD in the Middle East. But data has suggested that the UAE has a high prevalence of the disease. In 2008, RHD accounted for 4,099 DALYs in the UAE, draining vital healthcare resources. This burden is set to remain essentially constant in the long-term unless screening programmes are introduced.
RHD is a chronic heart condition caused by rheumatic fever that can be prevented and controlled. Rheumatic fever is caused by a preceding group A streptococcal (strep) throat infection. Treating strep throat with antibiotics can prevent rheumatic fever. Moreover, regular antibiotics (usually by injections every three to four weeks) can prevent patients with rheumatic fever from contracting further strep infections and causing progression of valve damage.
RHD is a substantial global health problem that can result in irreversible heart damage and death. It occurs predominately in developing countries and is also common in poorer populations in middle-income countries (e.g. Brazil, India) and some indigenous populations in wealthy countries (Australia, New Zealand). RHD will continue to be a global problem unless current prevention initiatives are expanded and sustained.
Previous estimates state that more than 15 million people have RHD and that 350,000 people die each year while many more are left disabled.