Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul 29;113(3):345-354.
doi: 10.5935/abc.20190141. eCollection 2019.

Rheumatic Fever: A Disease without Color

[Article in English, Portuguese]
Estevão Tavares de Figueiredo  1 , Luciana Azevedo  2 , Marcelo Lacerda Rezende  2 , Cristina Garcia Alves  2
Affiliations

Rheumatic Fever: A Disease without Color

[Article in English, Portuguese]
Estevão Tavares de Figueiredo et al. Arq Bras Cardiol. .

Abstract

Background: Brazil has approximately 30.000 cases of Acute Rheumatic Fever (ARF) annually. A third of cardiovascular surgeries performed in the country are due to the sequelae of rheumatic heart disease (RHD), which is an important public health problem.

Objectives: to analyze the historical series of mortality rates and disease costs, projecting future trends to offer new data that may justify the need to implement a public health program for RF.

Methods: we performed a cross-sectional study with a time series analysis based on data from the Hospital Information System of Brazil from 1998 to 2016. Simple linear regression models and Holt's Exponential Smoothing Method were used to model the behavior of the series and to do forecasts. The results of the tests with a value of p < 0.05 were considered statistically significant.

Results: each year, the number of deaths due to RHD increased by an average of 16.94 units and the mortality rate from ARF increased by 215%. There was a 264% increase in hospitalization expenses for RHD and RHD mortality rates increased 42.5% (p-value < 0.05). The estimated mortality rates for ARF and RHD were, respectively, 2.68 and 8.53 for 2019. The estimated cost for RHD in 2019 was US$ 26.715.897,70.

Conclusions: according to the Brazilian reality, the 1-year RHD expenses would be sufficient for secondary prophylaxis (considering a Benzatin Penicillin G dose every 3 weeks) in 22.574 people for 10 years. This study corroborates the need for public health policies aimed at RHD.

PubMed Disclaimer

Conflict of interest statement

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1
Growth trends and predicted values for Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD) mortality rates. The model equation for the trend of the ARF (A) mortality rate was ARFMT = –237,79 + 0,12* Year, whereas for the trend of the RHD mortality rate (C) it was RDHMT = –286,11 + 0,15* Year. It should be noted that all trends were significant (p-value < 0.050), evidencing the increasing trend of the series over time.
Figure 2
Figure 2
GAS: Group A β-hemolytic Streptococcus. Hypothetical scenario based on the current panorama of rheumatic fever in Brazil, after crossing data from the Brazilian Institute of Geography and Statistics with data from the REMEDY study,16 showing the evolution of Acute Rheumatic Fever to Rheumatic Heart Disease, with their respective morbidities in numbers.
Figure 3
Figure 3
Growth trends (A) and predicted values (B) for total costs with RHD. The model equation for the total costs with RHD (C) was RDHTC = –8346,31 + 4,19* Year. It should be noted that all trends were significant (p-value < 0.050), evidencing the increasing trend of the series over time.
Figure 4
Figure 4
Projection of estimated minimum annual costs in US dollars for Rheumatic Heart Disease morbidities. The final values were calculated based on the case estimates made in Figure 2, multiplying by the values detailed in Table 1, taking into account only one procedure or one hospitalization for each patient over time.
Figure 5
Figure 5
Comparison between the increase of mortality rates for Rheumatic Heart Disease (RHD), Prostate Cancer (PC) and Breast Cancer (BC). According to the adjustment of a simple linear regression for each of the series, the trends for RDH (0.15 [0.12, 0.17]) and BC (0.14 [0.07, 0.22]) were significant (p-value < 0.050) and did not show any significant difference, as the confidence intervals overlapped. The trend for PC (0.04 [-0.04; 0.12]) was not significant (p-value > 0.050).
See this image and copyright information in PMC

Comment in

References

    1. Braga ALL, Achutti AC, Ramos AIO, Weksler C, Mota CCC, Santos CCL, et al. Diretrizes Brasileiras para o Diagnóstico, Tratamento e Prevenção da Febre Reumática. Arq Bras Cardiol. 2009;93(3 Suppl 4):1–18. - PubMed
    1. Veasy LG, Tani LY, Daly JA, Korgenski K, Miner L, Bale J, et al. Temporal association of the appearance of mucoid strains of Streptococcus pyogenes with a continuing high incidence of rheumatic fever in Utah. Pt 1Pediatrics. 2004;113(3):e168–e172. - PubMed
    1. Bisno AL, Gerber MA, Gwaltney JM, Kaplan EL, Schwartz RH, Infectious Diseases Society of America Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Infectious Diseases Society of America. Clin Infect Dis. 2002;35(2):113–125. - PubMed
    1. WHO Rheumatic fever and rheumatic heart disease. World Health Organ Tech Rep Ser. 2004;923:1–122. - PubMed
    1. Moran M, Guzman J, Abela-Oversteigen L, Liyanage R, Omune B, Wu L, et al. Neglected disease research and development?: is innovation under threat?? Policy Cures. 2011