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(BQ) Part 2 book Prevention of cardiovascular diseases from current evidence to clinical practice presents the following contents: Chagas disease - A neglected disease; prevention and control of cardiovascular diseases - Policies, strategies and interventions; prevention and control of cardiovascular diseases focusing on low and middle income countries; posttraumatic stress disorder and cardiovascular disease,...
Rheumatic Heart Disease: A Neglected Heart Disease Marcia de Melo Barbosa, Maria Carmo Pereira Nunes, and Regina Müller Acute Rheumatic fever (ARF) and its chronic sequel, rheumatic heart disease (RHD) result from an autoimmune disease that starts with an infection caused by Streptococcus pyogenes (Group A streptococci—GAS) and remain the most common cause of preventable childhood heart disease worldwide It follows a nontreated throat infection in susceptible children and teenagers (3- to 19-years old); and strongly relates to socioeconomic and environmental determinants, such as overcrowding, poor standard of living, poor access to medical care and inadequate expertise of health-care teams [1, 2] Epidemiology Despite being considered today as “virtually eliminated” [3] after a documented decrease in the incidence of ARF in developed countries during the past decades, RHD remains a medical and public health problem, especially in low and middleincome countries and in indigenous populations, where it causes disability and M de Melo Barbosa, M.D., Ph.D (*) ECO Center, Hospital Socor, Belo Horizonte, Brazil Interamerican Society of Cardiology e-mail: marciambarbosa@terra.com.br M Carmo Pereira Nunes, M.D School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil e-mail: mcarmo@waymail.com.br R Müller, M.D., Ph.D Working Group on Rheumatic Fever from the World Heart Federation, Geneva, Switzerland National Heart Institute of Rio de Janeiro, Rio de Janeiro, Brazil e-mail: reginamuller@globo.com © Springer International Publishing Switzerland 2015 J.P Andrade et al (eds.), Prevention of Cardiovascular Diseases, DOI 10.1007/978-3-319-22357-5_15 143 144 M de Melo Barbosa et al premature death in children and young adults in their most productive years [1] As stated recently, RHD does not get the same attention as cancer as a chronic noncommunicable disease (NCD) “because it is a disease of the bottom billion of the poorest people in the world—one of the most neglected of the neglected diseases” [2] In 2005, the World Health Organization (WHO) estimated a prevalence of at least 15.6 million cases of RHD worldwide, with 282,000 new cases (ARF) and 233,000 deaths related to RHD each year The burden of stroke due to RHD in less developed countries was also considered: 144,000–360,000 new strokes each year [4] However, these are conservative assumptions, and future incoming-data will show these figures to be dramatically underestimated [5] In Brazil, estimates based on WHO epidemiological model and data from the last Census in 2010, appointed to around 30,000 new cases of ARF each year, of which around 12,800 can develop RHD [1, 6] Brazilian official figures have shown a significant reduction in the number of hospitalizations due to ARF and RHD in the last 10 years, however, in 2012, 2713 ARF and 4268 RHD hospital admissions were still reported [7], since, similar to other countries, Brazil has not yet implemented a national register system and a RHD control program Underreporting of cases and difficulties in access to hospital admission, especially for adolescents and young adults, are very common In a recent linkage study with 53,210 Brazilian in-hospital children and adolescents admitted for heart failure (HF) from 2001 to 2007 the survival analysis for the ARF/RHD patients showed only 61 %, 55 % and 36 % survival rate at 1, and years, respectively, with a hazard ratio observed for RHD patients’ death of 15.5 These poor results were strongly related to social conditions measured by human development index (HDI) of the patients’ residence [8] Another Brazilian study with 100 RHD low-income patients in Sao Paulo analyzing the entire course of the disease concluded that costs of ARF/RHD amounted to approximately 1.3 % of the annual family income in this population Direct and indirect costs, such as school failure rate of 22 %, 23 % parents’ work absenteeism, about % lost jobs, and the intangible costs associated with RHD, resulting from premature disability and death, and loss of intellectual opportunities, with its adverse effects on the socioeconomic family and society development The estimated annual cost of RF for society in Brazil was estimated in 2001 as US$ 51,144,347.00 [9] More recently, advocacy groups, including the World Heart Federation (WHF), have put greater efforts into rectifying this neglect disease [2] In April 2013, the WHF issued a statement of commitment to the strategic objective of a 25 % reduction in premature deaths from ARF and RHD among individuals aged