6 data points about rheumatic heart disease as global rates decline

Over the past quarter-century, the worldwide burden of rheumatic heart disease has declined although high rates of the illness persist in certain poor regions, including Oceania, South Asia and sub-Saharan Africa, a new study finds.

The study was published online Aug. 24 in the New England Journal of Medicine.

With improved living conditions and the widespread use of penicillin, both rheumatic fever and its sequela rheumatic heart disease are both nearly absent today in high-income countries.

“The remaining burden of rheumatic heart disease is found mostly in low-income and middle-income countries and among immigrants and older adults in high-income countries,” the authors wrote, led by David A. Watkins, MD, with the department of medicine at the University of Washington in Seattle.

With the World Health Organization and the World Heart Federation calling for a 25 percent drop in deaths due to cardiovascular causes by 2025, the research group set out to estimate the global, regional, and national burden of rheumatic heart disease for the years 1990 through 2015.

The authors performed a systematic literature review and used multiple sources of data and varied epidemiological modeling techniques to derive their findings. In total, they included 10,049 site-years of vital registration data from 132 countries in their analysis.

Here are some of their main conclusions:

• Worldwide, 319,400 deaths were due to rheumatic heart disease in 2015. This figure represents an 8.1 percent decrease in these deaths from 1990, when there were 347,500 deaths due to rheumatic heart disease.
• In 2015, there were 33.4 million cases of rheumatic heart disease and 10.5 million disability-adjusted life-years due to the illness.
• Global age-standardized mortality due to the disease decreased by 47.8 percent between 1990 and 2015, although there were large differences between regions.
• Highest age-standardized mortality due to and prevalence of the disease were observed in central sub-Saharan Africa, South Asia and Oceania.
• The countries hardest hit by the disease in 2015 include India (119,100 deaths), China (72,600 deaths), and Pakistan (18,900).
• In 2015, the highest age-standardized death rates, with more than 10 deaths per 100,000 population, included the Solomon Islands, Fiji, the Federated States of Micronesia, the Central African Republic and Lesotho.

Socioeconomic conditions play a decisive role in which countries bear the heaviest burden of this illness.

“In addition to impeding the effective prevention of acute rheumatic fever, social and economic factors may also make the management of chronic rheumatic heart disease more difficult,” the authors wrote, explaining that lifelong treatment options for the illness, though effective, place large demands on health systems.