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• W4386476999 abstract "Heart failure is a major cause of mortality globally.[1] The epidemiology of heart failure varies across countries with different stages of epidemiological transitions. In high income countries, ischemic heart disease is the leading cause of heart failure. In low-income countries, non-ischemic etiologies contribute substantial proportion of heart failure population. In sub-Saharan countries, rheumatic heart disease (RHD) is the third leading cause of heart failure after hypertension and dilated cardiomyopathy.[2] RHD affects about 33 million people globally, and India contributes about 40% of global RHD population and annually about 275,000 people die due to rheumatic fever (RF)/RHD.[3-5] The RF/RHD is a disease of poverty and is most prevalent among communities with poor housing conditions, household crowding and lack of access to quality health care services. There are no reliable estimates of prevalence of RF/RHD based on survey studies in nationally representative samples from India and other countries that are affected most. The morbidity and mortality in RF/RHD is the result of heart failure and thromboembolism. The acute valvular incompetence as a result of severe rheumatic carditis, left ventricle systolic dysfunction secondary to long standing pressure and volume overload and/or progressive increase in left ventricle inflow obstruction are the mechanisms of heart failure in patients with RF/RHD. The heart failure in RF/RHD could be prevented by ensuring guideline directed secondary prophylaxis, timely intervention with catheter or surgical based treatment and use of oral anticoagulants in select group of high-risk patients. Thus, heart failure in patients with RF/RHD is potentially preventable if patients are detected early and monitored closely to identify high-risk patients and are provided appropriate treatment accordingly. In the resource-constrained countries with poor access to quality health care, low health literacy rates and prevalent conducive social determinants for Group A Streptococcal pharyngeal infection are the major challenges in reducing the burden of heart failure and associated co morbidities in patients with RF/RHD. The data of Himachal Pradesh Rheumatic Fever Rheumatic Heart Disease (HP-RF/RHD) registry reported very high prevalence of heart failure and associated co morbidities; atrial fibrillation, pulmonary artery hypertension, and stroke are affecting predominantly young female population with lower socioeconomic state living in rural areas.[6,7] Thus, it highlights the importance and need of initiating population based registry through regional networking of primary and secondary health care centers and integrating with tertiary care hospitals for opportunistic screening, case detection, ensuring secondary prophylaxis and monitoring for high-risk patients and providing appropriate treatment at appropriate time. The register-based program is effective in prevention and control of RF/RHD and associated morbidity and mortality.[8-10] The severity of valvular heart disease and the risk of heart failure increase with time. The data of HP-RF/RHD registry reported the incidence and severity of mitral valve stenosis increase with age whereas there is no significant change in the severity of mitral and aortic incompetence. The mechanistic pathways responsible for the progression of mitral stenosis are not known. The RHD is an autoimmune disorder; the histopathological studies of rheumatic valves show the inflammatory infiltrates. The levels of inflammatory cytokines are raised and correlated with the severity of valvular dysfunction. Future studies investigating the role of inflammatory pathways in activating fibroblasts with increased synthesis, deposition of collagen matrix, and the potential role of targeted anti-inflammatory agents need to be explored. Editorial Comment on. Negi et al. Heart failure in RHD, characteristics and determinants: HP-RF/RHD registry study. Heart Failure Journal of India 2023;XX:XX-XX. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest." @default.
• W4386476999 created "2023-09-07" @default.
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• W4386476999 date "2023-01-01" @default.
• W4386476999 modified "2023-10-03" @default.
• W4386476999 title "Heart failure in rheumatic fever and rheumatic heart disease" @default.
• W4386476999 doi "https://doi.org/10.4103/hfji.hfji_2_23" @default.
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