Improvement of Rheumatic Valvular Heart Disease in Patients Undergoing Prolonged Antibiotic Prophylaxis.

Renato Pedro De Almeida Torres,Gabrielle De Crombrugghe,Scarllet Palacin Moraes Da Silva,Rômulo Francisco De Almeida Torres,Pierre R Smeesters,Karine Alessandra Bosi,Sarah Leticia Veroneze Cordeiro,Rosângela Stadnick Lauth De Almeida Torres

doi:10.3389/fcvm.2021.676098

Abstract

Secondary prophylaxis of rheumatic heart diseases is efficient in reducing disease recurrence, heart damage, and cardiac impairment. We aimed to monitor the clinical evolution of a large Brazilian cohort of rheumatic patients under prolonged secondary prophylaxis. From 1986 to 2018, a cohort of 593 patients with rheumatic fever was followed every 6 months by the Reference Center for the Control and Prevention of Rheumatic Fever and Rheumatic Cardiopathy (CPCFR), Paraná, Brazil. In this cohort, 243 (41%) patients did not present cardiac damage (group I), while 350 (59%) were diagnosed with rheumatic heart disease (RHD) (group II) using the latest case definition. Among group II, 233 and 15 patients had impairment of the mitral and aortic valves, respectively, while 102 patients had impairment of both valves. Lesions on the mitral and aortic valves presented a regression in 69.9 and 48.7% of the patients, respectively. Active patient recruitment in the reference center and early detection of oropharyngeal GAS were important factors for optimal adherence to the prophylactic treatment. Patients with disease progression were associated with noncompliance to secondary prophylaxis. No patients undergoing regular prophylaxis presented progression of the rheumatic cardiac disease. Eighteen valvular surgeries were performed, and four (0.7%) patients died. This study confirmed that tailored and active efforts invested in rheumatic heart disease secondary prevention allowed for significant clinical improvement.

Highlights

Acute rheumatic fever (ARF) is an inflammatory, autoimmune disease induced by a throat infection caused by Streptococcus pyogenes (Group A β-hemolytic Streptococcus—GAS) in genetically predisposed individuals
Most cases of ARF occur in Secondary Prophylaxis of Rheumatic Heart Disease low- and middle-income countries where limited resources are often available for optimal health programs
The follow-up time ranged from 2 to 26 years with almost half of the patients (47.6%) followed for more than 11 years (Table 1). All patients started their prophylactic treatment with IM penicillin every 3 weeks, as recommended by the American Heart Association (AHA) for populations with high incidence of rheumatic fever [6]

Summary

Introduction

Acute rheumatic fever (ARF) is an inflammatory, autoimmune disease induced by a throat infection caused by Streptococcus pyogenes (Group A β-hemolytic Streptococcus—GAS) in genetically predisposed individuals. Global prevalence of rheumatic heart disease (RHD) is estimated to be 33.4 million and is responsible for about 319,400 deaths per year [1]. Most cases of ARF occur in Secondary Prophylaxis of Rheumatic Heart Disease low- and middle-income countries where limited resources are often available for optimal health programs. In Brazil, a significant amount of financial resources from the Brazilian Unified Health System (SUS) is intended to assist and treat ARF and RHD patients [2, 3]. Prophylaxis remains, so far, the most effective treatment option to prevent RHD recurrences. Benzathine penicillin-based prophylaxis, every 3–4 weeks, remains the treatment of choice since GAS continues to be fully susceptible to penicillin [6, 7]

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