RHEUMATIC HEART DISEASE

Transcription

1 RHEUMATIC HEART DISEASE DIAGNOSTIC CRITERIA, TREATMENT AND PREVENTION BODE-THOMAS, F. DEPARTMENT OF PAEDIATRICS, UNIVERSITY OF JOS/TEACHING HOSPITAL

2 OUTLINE Overview/characteristics/burden Diagnostic features/criteria Treatment & Prevention RHD Control Where are we in Nigeria? The global perspective

3 RHD: the acquired heart disease of poverty Highly preventable Devastating effects mostly on: Young persons Pregnant women

4 Global Burden of RHD [2015] >33 million cases ~319,400 deaths [most aged <40 years] ~350,000 new cases

5 50% of RHD burden in school children is in sub-saharan Africa

6 RHD: causal pathway & characteristic features Infectious origin Chronic/life-long morbidity Expensive medical care Thrives in under-resourced, overstretched health care systems

7 RHD: diagnosis Clinical Chronic heart failure in an older child / adolescent / young adult is often RHD until otherwise proven Typical physical examinations findings of valve disease Usually diagnosed late & in tertiary centres early stages missed at primary and secondary levels of healthcare Echocardiographic Confirmation of clinical findings Typical echo findings of RHD / valve pathologies Late diagnosis Limited access to surgical intervention Early diagnosis echo screening WHO criteria WHF criteria

8 Role of echocardiography in diagnosis of RHD Indispensable Confirms rheumatic aetiology of valve lesions / helps to exclude non- RHD causes Assessing severity, haemodynamic effects of valve lesions Follow-up of patients, timing of interventions

9 Some typical echocardiographic features of RHD

10 Chamber dilatation, leaflet thickening & prolapse of AML

11 Doming or ballooning of AML elbow deformity or hockey stick appearance

12 Posteriorly directed jet in rheumatic mitral regurgitation

13 Early diagnosis of RHD: role of echocardiographic screening Diagnosis of sub-clinical RHD by echo screening using portable and hand-held devices WHO vs WHF criteria

14 Abridged WHF diagnostic echocardiographic screening criteria for RHD diagnosis Quite cumbersome (i.e., for large-scale field application) Simplified protocols MV (function, morphology) Task-shifting

15 RHD CAUSAL PATHWAY AND OPPORTUNITIES FOR INTERVENTION Increase awareness

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17 RHD control in Nigeria Primary care level nil Secondary level extremely scanty Tertiary level Medical management of RF/RHD Some secondary prophylaxis Isolated echo screening

18 Evaluation of RHD control in Nigeria: inferences from the REMEDY study Complications in 64% at enrolment Secondary prophylaxis in 55% Inadequate use of anti-coagulants when indicated Women of child-bearing age: 3.6% were on contraceptives Another 3.6% pregnant at enrolment Better access to valve surgeries in Upper-middle income countries There is a need to publish the Nigerian REMEDY data & establish a national RHD registry

19 - Increased attention to follow-up appointments and details in patient records - Increased use of penicillin prophylaxis - More frequent INR monitoring and contraceptive counselling - Improved healthcare workers knowledge and efficacy in caring for RHD patients

20 Management of RHD in Nigeria - effect of the REMEDY study Primary care level nil Secondary level extremely scanty Tertiary level A few RF/RHD registers established; priority care? Medical management of RF/RHD Some secondary prophylaxis (strengthened) Isolated echo screening

21 RHD control in Nigeria - other activities Engagement with state governments across the country and the FMoH

22 Health worker training in Osun State; Community education in Plateau State. RHD control in Nigeria - other activities

23 RHD control in activities Nigeria: summary Isolated. Disjointed Uncoordinated, efforts Need for a national policy on RHD control

24 Urgent need for a national policy on RHD control in Nigeria: the global perspective Neglected for decades (research, disease control efforts) Increasing research output / attention in the last one and a half decades Global advocacy efforts recently culminated in a World Health Assembly resolution

25 The WHA resolution on RHD: Calls on member states to take action in five areas Improve access to primary health care Strengthen data collection and knowledge of RHD prevalence in endemic countries Ensure affordable and reliable access to technologies and medicines Strengthen national and international cooperation Tackle the root determinants of RF/RHD

26 Secondly. The resolution invites all stakeholders to collaborate with WHO and member states in order to: Put people living with RHD at the centre of the prevention and control agenda Raise the profile of PLWRHD and other NCDs of children and adolescents on the global health agenda Support & facilitate timely, affordable and reliable access to existing and new cost-effective medicines and technologies for the prevention and control of RHD

27 Finally, The resolution makes 5 requests to the Director-General of WHO 1. Lead and coordinate global efforts to prevent and control RHD 2. Support member States to measure their RHD burdens and implement programmes 3. Foster international partnerships 4. Monitor efforts for the prevention and control of RHD 5. Report on implementation of this resolution to the 74 th WHA, which will be held in 2021

28 To this end, The national RHD task team of the NCS has written to again seek audience with the Hon. FMoH, and to Offer our whole-hearted support to the Ministry for the convening of a national meeting of stakeholders that will work to formulate a national policy on RHD prevention & control

29 Direct healthcare cost of failing to control RHD Total population of Nigeria 180,000,000 Estimated population prevalence of advanced RHD Total advanced RHD population in need of surgery Surgical cost per patient Follow-up cost per patient per year Cost of preventing advanced RHD per patient per year Cost of primary prevention per sore throat episode 0.05% (conservative) 90,000 N5 Million (~13,500 USD) 500 USD (~N185,000) 4 USD x 12 = $48 (<50 USD / <N20,000) per year <5USD (<N2,000)

30 Ulau:. Chronic RHD for years Eventually benefitted from a charitable OHS programme in Italy Died suddenly at home. Wasted efforts/resources?

31 Nigeria: other costs of failure to control RHD Direct healthcare costs indirect healthcare costs Loss of economic productivity Economic & social burden on individual sufferers, families, healthcare system & the nation as a whole Premature deaths loss to

32 Other costs of NOT controlling RHD in Nigeria Loss of productivity DALYs lost Crippling, death of young people in their most productive years Loss of their contribution to national development

33 Golden opportunity To collaborate with stakeholders Internationally Nationally And eliminate this preventable condition

34 Thank you for your attention