Rheumatic heart disease is significantly under-treated in Africa and India

Rheumatic heart disease (RHD) is significantly under-treated in Africa and India according to the preliminary findings of a new global study presented today at the World Congress of Cardiology.

Across the African and Indian regions included in the study it was revealed that patients are not receiving the surgery they need, secondary prevention with penicillin - to prevent further attacks of rheumatic fever - is being under-utilized and many patients are unaware of their target anti-coagulation levels.

Specifically, only 41 per cent of patients enrolled in the study had received surgery. As the pilot results included a large tertiary academic centre, this does not reflect the dire lack of surgery available at the majority of enrolling centers. In fact, more than 85 per cent of the enrolling centres do not have surgery available on a regular basis for RHD patients.

Nearly one-quarter of all patients (22 per cent) were in atrial fibrillation and of these patients, only 65 per cent were receiving necessary anti-coagulant therapy. Moreover, 71 per cent of these patients did not know their target international normalized ratio (INR) - an indicator of blood clotting time - 14 per cent had no INR reading in the six months prior to enrolling in the study and 78 per cent were not at their INR target.

The study results further showed that only 36 per cent of patients with moderate or severe disease and only 20 per cent of those that have undergone valve replacement surgery are receiving secondary prophylaxis with penicillin.

"Across Africa and India it is widely known by cardiologists that many patients with RHD do not have access to the healthcare treatment they need. These results unfortunately show that even those that are being treated are not receiving the care they need, for a variety of reasons," said Dr. Liesl Züklhe, Paediatric Cardiologist, Red Cross Children's Hospital, University of Cape Town, South Africa. "These preliminary results are the first step in really understanding the extent of the problems that the RHD community are facing. We urgently need to accumulate robust data and investigate the barriers of care that exist in order to control this disease. Hopefully this will reinforce the need for political commitment and action to fight this disease."

Rheumatic heart disease is the most serious complication of rheumatic fever. Acute rheumatic fever follows 0.3% of cases of group A beta-hemolytic streptococcal pharyngitis in children. As many as 39% of patients with acute rheumatic fever may develop varying degrees of pancarditis with associated valve insufficiency, heart failure, pericarditis, and even death. With chronic rheumatic heart disease, patients develop valve stenosis with varying degrees of regurgitation, atrial dilation, arrhythmias, and ventricular dysfunction. Chronic rheumatic heart disease remains the leading cause of mitral valve stenosis and valve replacement in adults in the United States.