Doctors ‘failing to diagnose rheumatic heart disease’

DOCTORS are failing to diagnose and manage rheumatic heart disease properly, needlessly placing the lives of many pregnant women and their unborn babies at risk, according to new research published on Wednesday in the European Heart Journal.

Rheumatic heart disease is caused by rheumatic fever, a rare auto-immune condition associated with untreated childhood streptococcus A throat infections, in which the body attacks itself. Over time, repeated strep A infections in these patients weaken the heart, posing particularly high risks to pregnant women. Yet all it takes to treat these infections and prevent further attacks is penicillin, a cheap and readily available drug.

“Only half of patients who are severely affected by rheumatic heart disease in SA are getting penicillin and that is a disgrace,” said Prof Bongani Mayosi, head of the department of medicine at Groote Schuur Hospital and University of Cape Town and lead researcher of the Global Rheumatic Heart Disease Registry (the Remedy study). The research is intended to provide a baseline against which countries can measure their progress towards a United Nations (UN) goal to reduce deaths from noncommunicable diseases by 25% by 2025.

“Rheumatic heart disease is a disease of poverty, neglected by the health ministries in affected countries and by the international community in general,” he said.

The Remedy study researchers studied 3,343 patients at 25 hospitals in 12 African countries, India and Yemen. South African and Namibian hospitals accounted for 863 of the patients.

Just 4% of the 1,825 women in the study who were of child-bearing age were using contraception, an “utterly shocking” finding, given the risks that pregnancy posed to women with rheumatic heart disease, said Prof Mayosi. Pregnancy placed extra strain on the heart because of the extra blood volume it needed to pump: by the second trimester a pregnant woman’s blood volume had typically increased by 40%, he said.

“The fact that only 4% of women with rheumatic heart disease have contraceptive services available to them is a disaster. We are neglecting what is possibly the most important intervention

“Rheumatic heart disease is a big contributor to maternal mortality, and it is one of the reasons we are not meeting our Millennium Development Goals” he said.

Prof Mayosi said cardiologists needed to do a better job of counselling women with rheumatic heart disease about the risks associated with pregnancy.

The researchers also found one in five pregnant women with rheumatic heart disease were taking a blood thinner called warfarin, despite the fact that this drug poses dangers to the foetus. Warfarin is used to prevent strokes in patients with rheumatic heart disease.

Prof Mayosi said strep A throat infections could be easily diagnosed based on clinical symptoms, and that the risk of a child who was not treated developing rheumatic fever largely depended on their social conditions: poor children were much more likely to develop the condition, he said. There was no association with HIV, he said.

Rheumatic heart disease is responsible for up to 1.4-million deaths every year, mostly in low and middle-income countries.

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