Rheumatic heart disease on the rise in India

Incidence of rheumatic heart disease (RHD) - a chronic heart condition caused by rheumatic fever -- is much higher in India than what is presently believed.

Just months after TOI reported how RHD among Indian children could be 20 times more than what is believed, a study presented at the World Congress of Cardiology in Dubai on Saturday said RHD is significantly under-treated in India.

The study conducted by South African researchers found that only 36% of patients with moderate or severe disease and only 20% of those that have undergone valve replacement surgery in India and Africa are receiving secondary prophylaxis with penicillin. Only 41% of patients enrolled in the study had received surgery.

A study conducted by AIIMS in and around Delhi to see prevalence of RHD among children in northern India had earlier found prevalence of 20.4/1000 school children as against 1 per 1000 children earlier believed.

RHD was twice as prevalent among children aged 11-15 years (prevalence of 26.5 per 1000 children) compared to children aged 5-10 years (12.6 per 1000 children). Girls had a higher prevalence of RHD (27.9/1000 girls) compared to boys (13.3/1000 boys).

The study said though RHD was thought to be on the decline in India because of improving standards of living, the estimated prevalence of echocardiograpically detected RHD in India was comparable to those measured in Mozambique (21.5 cases per 1000).

Dr K Srinath Reddy, the new president of the World Heart Federation told TOI from Dubai, "RHD is a priority for us now and can't be neglected anymore. Though India feels it has managed to control RHD, the prevalence of the disease is still high in states like Uttar Pradesh and Bihar. Penicillin is the most basic requirement to treat RHD but most pharmaceutical companies aren't making them anymore leading to its shortage."

Dr Liesl Zuklhe from Red Cross Children's Hospital, University of Cape Town, said, "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, These preliminary results are the first step in really understanding the extent of the problems that the RHD community are facing."

These data represent the first findings from the RHD global registry (REMEDY), which is currently ongoing in almost 30 centres in Africa, Middle East and India.

Five hundred and seventy-nine patients from 10 sites in Africa and India were enrolled in the REMEDY study during the first 10-month pilot period as part of a global effort to better understand the situation today.

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 (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.

Dr Anita Saxena from AIIMS said RHD can cause chronic heart valve damage which can eventually lead to heart failure. She said in case of an RHD, two valves of the heart among the four get affected. The mitrial valve is the commonest sufferer. "Echocardiographic screening for RHD must be done more rigorously," she said.

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