CORRESPONDENCE: LETTER TO THE EDITOR
Early Detection of Rheumatic Heart Disease and Prevention of Heart Failure in Sub-Saharan Africa
Eloi Marijon, MD* and
Xavier Jouven, MD, PhD
* Université Paris-Descartes, Hôpital Européen Georges Pompidou, Département de Cardiologie, 20 rue Leblanc, 75908 Paris Cedex 15, France (Email: eloi_marijon{at}yahoo.fr).
In a recent issue of the Journal, Damasceno et al. (1) highlighted the need for action to reduce the prevalence of heart failure in sub-Saharan Africa, where this pathology is an important cause of mortality as well as a serious economic burden. Rheumatic heart disease is the most frequent cause of heart failure in this region of the world and is responsible for at least one-third of cases. In this context, the authors are prudent to insist on the need for a strategy of prevention with regards to risk factors for heart failure. Nevertheless, we would like to underline important new findings that should be considered when attempting to reduce the incidence of this life-threatening pathology.
Recently, an echocardiographic approach demonstrated that the prevalence of rheumatic heart disease in sub-Saharan Africa was 10x higher than previously reported (2). In other words, 9 out of 10 children have only minor infra-clinical rheumatic valve lesions and would not have been detected by the clinical criteria used in previous surveys. Secondary prophylaxis measures, based on monthly penicillin injections in children after a first episode of acute rheumatic fever and continued until the third decade, have been shown to be inexpensive and efficient. This therapeutic strategy is best delivered as part of a register-based control program, providing education and enabling better clinical follow-up. This approach has been recommended by the World Health Organization and the World Heart Federation since the 1980s.
Comprehensive echocardiographic screening programs could also enhance effective prevention strategies for rheumatic heart disease. Early detection of "subclinical" rheumatic valve disease is vital, as it presents an opportunity for case detection at a time when prophylactic penicillin can prevent progression to clinical valve disease and heart failure in young adult life.
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1. Damasceno A, Cotter G, Dzudie A, Sliwa K, Mayosi BM. Heart failure in sub-Saharan Africa: time for action J Am Coll Cardiol 2007;50:1688-1693.[Free Full Text]2. Marijon E, Ou P, Celermajer DS, et al. Prevalence of rheumatic heart disease detected by echocardiographic screening N Engl J Med 2007;357:470-476.[Abstract/Free Full Text]
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- Albertino Damasceno, Gad Cotter, Anastase Dzudie, Karen Sliwa, and Bongani M. Mayosi
J. Am. Coll. Cardiol. 2008 51: 1126.
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