Rheumatic Heart Disease in the United States: Forgotten But Not Gone
Sarah de Loizaga, Lindsay Arthur, Bhawna Arya, Brian R. Beckman, Belay Anagaw, Cole Brokamp, Nak Hyun Choi, Seán Connolly, Soham Dasgupta, Tavenner Dibert, Marylou M. Dryer, L. Gokanapudy, E. Anne Greene, Daphney Kernizan, Omar Khalid, Jennifer Klein, Ryan Kobayashi, Subhrajit Lahiri, Raymond Lorenzoni, Andrea Otero Luna, Jennifer Marshall, Theodore J Millette, Lily Moore, Babu Muhamed, Meghna Murali, Kinjal Parikh, Amy Sanyahumbi, Divya Shakti, Elizabeth Stein, Sanket Shah, Hannah Wilkins, McAllister Windom, Scott Wirth, Meghan Zimmerman, Andrew F. Beck, Nicholas J. Ollberding, Craig Sable, Andrea Beaton
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 antibiotic 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.