Rheumatic Heart Disease in the United States: Forgotten But Not Gone Results of a 10 Year Multicenter Review

• Authors: Sarah R de Loizaga, Cincinnati Children's Hospital Medical Center; Linday Arthur, University of Arkansas Medical Sciences; Bhawna Arya, University of Washington; Brian Beckman, Nationwide Children's Hospital; Wubishet Belay, Monroe Carell Jr Children's Hospital at Vanderbilt; Cole Brokamp, Cincinnati Children's Hospital Medical Center; Nak Hyun Choi, Columbia University; Sean Connolly, Ann & Robert H Lurie Childrens Hosp Chicago; Soham Dasgupta, Emory University; Tavenner Dibert, University of Florida Health; Marylou M Dryer, University of Rochester; Lakshmi R Gokanapudy Hahn, Washington University; Elizabeth A Greene, University of New Mexico; Daphney Kernizan, Nemours/Alfred I. duPont Hospital for Children; Omar Khalid, Nationwide Childrens Hospital; Jennifer Klein, Children's National Hospital; Ryan Kobayashi, Boston Children's Hospital; Subhrajit Lahiri, Texas Childrens Hospital; Raymond P Lorenzoni, Children's Hospital at Montefiore; Andrea Otero Luna, Yale New Haven Medical Center; Jennifer Marshall, Children's National Hospital, Washington DC; Theodore Millette, University of Mississippi; Lily Moore, University of Mississippi; Babu Muhamed, Children's National Hospital, Washington DC; Meghna Murali, Children's National Hospital, Washington DC; Kinjal Parikh, Nicklaus Childrens Hospital; Amy Sanyahumbi, Texas Childrens Hospital; Divya Shakti, University of Mississippi; Elizabeth Stein, University of Washington; Sanket Shah, Childrens Mercy Hosp; Hannah Wilkins, University of Arkansas Medical Sciences; McAllister Windom, Duke Children's Hospital & Health Center; Scott Wirth, Cincinnati Children's Hospital Medical Center; Meghan Zimmerman, Children's National Hospital, Washington DC; Andrew F Beck, Cincinnati Children's Hospital Medical Center; Nicholas Ollberding, Cincinnati Children's Hospital Medical Center; Craig Sable, Children's National Hospital, Washington DC; Andrea Beaton, Cincinnati Children's Hospital Medical Center
• Journal Title: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• Volume: Volume 10, Number 16
• Publisher: WILEY | 2021-08-17, Pages e020992-e020992
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1161/JAHA.120.020992
• Subjects: Health Sciences, Human Development; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; acute rheumatic fever; deprivation; pediatric; rheumatic heart disease; socioeconomic status; United States; SCIENTIFIC STATEMENT; FEVER; DIAGNOSIS; CHOREA; ECHOCARDIOGRAPHY; RECOMMENDATIONS; AUSTRALIA

Abstract

BACKGROUND: Recent evaluation of rheumatic heart disease (RHD) mortality demonstrates disproportionate disease burden within the United States. However, there are few contemporary data on US children living with acute rheumatic fever (ARF) and RHD. METHODS AND RESULTS: Twenty-two US pediatric institutions participated in a 10-year review (2008– 2018) of electronic medical records and echocardiographic databases of children 4 to 17 years diagnosed with ARF/RHD to determine demographics, diagnosis, and management. Geocoding was used to determine a census tract-based socioeconomic deprivation index. Descriptive statistics of patient characteristics and regression analysis of RHD classification, disease severity, and initial anti-biotic prescription according to community deprivation were obtained. Data for 947 cases showed median age at diagnosis of 9 years; 51% and 56% identified as male and non-White, respectively. Most (89%) had health insurance and were first diagnosed in the United States (82%). Only 13% reported travel to an endemic region before diagnosis. Although 96% of patients were prescribed secondary prophylaxis, only 58% were prescribed intramuscular benzathine penicillin G. Higher deprivation was associated with increasing disease severity (odds ratio, 1.25; 95% CI, 1.08–1.46). CONCLUSIONS: The majority of recent US cases of ARF and RHD are endemic rather than the result of foreign exposure. Children who live in more deprived communities are at risk for more severe disease. This study demonstrates a need to improve guideline-based treatment for ARF/RHD with respect to secondary prophylaxis and to increase research efforts to better understand ARF and RHD in the United States.