Has the prevalence of rheumatic fever/rheumatic heart disease really changed? A hospital-based study

Abstract

Background: Rheumatic fever and rheumatic heart disease still remain major public health problems. With a dramatic rise in the incidence of coronary artery disease cases, the focus of the physician seems to be shifting away from rheumatic fever and rheumatic heart disease. The aim of the present study was to assess the prevalence of rheumatic fever and rheumatic heart disease, and to ascertain if there was any decline in the prevalence of the disease. For the first time, data on the prevalence of rheumatic fever and rheumatic heart disease are reported from Orissa, an underdeveloped state in eastern India.

Methods and results: We scrutinized the records of cardiac patients admitted to the medicine, pediatrics and cardiology wards of the SCB Medical College and Hospital, Cuttack from 1981 to 1990 and 1991 to 2000. During the period 1981-1990, out of 11,782 cardiac patients, 5537 (46.9%) were suffering from rheumatic fever and rheumatic heart disease. During 1991-2000, out of 14,803 cardiac patients, 6670 hospitalized patients (45%) were found to have rheumatic fever and rheumatic heart disease. During the first and second periods, the number of patients with rheumatic fever admitted was 1079 (9.2%) and 1330 (8.9%), respectively. The decline in the percentage of rheumatic fever cases was statistically not significant (p>0.05). During the two periods, the number of rheumatic heart disease patients admitted was 4458 (37.8%) and 5340 (36.1%), respectively. During both the periods studied, the decline in the percentage of rheumatic heart disease cases admitted was statistically not significant (p>0.05). We also compared rheumatic fever and rheumatic heart disease cases admitted during 1981-1985 with those admitted during 1996-2000. This analysis also did not show any demonstrable decline in the prevalence of the disease (2692 [46.2%] v. 3296 [44.4%], p>0.05).

Conclusions: Our results show that rheumatic fever and rheumatic heart disease cases constitute a significant percentage of the admissions of total cardiac cases to our hospital. Over the past 20 years, there is no significant decline in the percentage of rheumatic fever and rheumatic heart disease cases being admitted to a major government hospital.