Studies Investigate Cases of Rheumatic Heart Disease in North America

By Tamara Thomas - January 31, 2023

Rheumatic heart disease (RHD) is considered a disease of poverty, and most cases are found in low-income countries. However, according to a recent story published in the Journal of the American College of Cardiology, cases of the disease have appeared in North American clinics.

RHD is an autoimmune inflammatory reaction that occurs after one or more bouts of infection with Group A streptococci (GAS). It is sometimes referred to as a disease of deprivation because it almost always happens to people who don’t have reliable primary health care.

Overcrowding in homes, poor hygiene, and a lack of access to medical care are some socioeconomic factors that increase GAS exposure.

Furthermore, studies revealed that women are about 1.8 times more likely to be affected than men. This could be due to the inherent genetic differences and women being more likely to be exposed to GAS while raising children.

Even though RHD and its precursor, rheumatic fever, aren’t as common in  high-income countries as they used to be, that doesn’t mean they don’t happen. Moreover, It’s not just immigrant cases that show up at North American clinics.

“In the U.S., RHD is rare. Sometimes we see immigrants who present with RHD. But for anyone living in the U.S. or elsewhere in a setting where primary health care is poor or not readily accessed and where there’s any kind of crowding and lack of sanitation – which could just be school – there is the potential for untreated strep throat and rheumatic fever,” says Jeremiah Mwangi, MA, director of Policy and Advocacy at the World Heart Federation (WHF).

Two recent studies buttress this point. One 2021 study was led by pediatric cardiologists Sarah R. de Loizaga, MD, and Andrea Beaton, MD. According to this study, a majority of the most recent cases of acute rheumatic fever and RHD in the U.S. are caused by people who live there, not by people who come from other countries. A 10-year-old review of 22 U.S. pediatric medical centers found that 89% of patients had health insurance, while 82% were first diagnosed in the U.S. Of these patients, only 13% reported traveling to an endemic region before diagnosis.

The second study, carried out in 2022, cited data from the Society of Thoracic Surgeons. About 13% of 6625 mitral valve procedures were due to rheumatic disease. They also found that patients were younger, more often female, and had a higher prevalence of heart failure, multi-valve disease, and lung disease but less coronary artery disease.

However, as RHD spreads in developing countries and among vulnerable groups in developed countries, there is renewed interest in expanding the evidence base and developing and identifying novel methods to combat its numerous features.

For example, in 2018, the 71st World Health Assembly, the governing body of the World Health Organization (WHO), adopted a resolution on rheumatic fever/RHD that emphasized the need to treat RHD as a health priority.

The resolution strives to ensure access to primary and secondary prevention, quick and adequate diagnosis and treatment of GAS infection, acute rheumatic fever, and RHD, as well as improved data collection.

In its 2021 update on the resolution, the WHO said it was drafting a guideline for Member States to prevent and treat rheumatic fever and RHD.

“With this WHO resolution, the role of the WHF is to monitor its implementation and try to bring players together, gain political and financial support, and see where we can offer support and help move the needle,” said Mwangi.

Source: American College of Cardiology

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