Rheumatic heart disease anno 2020: Impacts of gender and migration on epidemiology and management

Abstract

Background: The epidemiology and management of diseases can be influenced by social demographic factors. Gender and migration are among these factors.

Methods: We aimed at reviewing the impacts of gender and migration on rheumatic heart disease (RHD) epidemiology and management by a nonsystematic literature review of published studies on RHD worldwide. Our PubMed search terms included RHD pathophysiology, diagnosis, complications, management or prevention, combined with words 'rheumatic mitral stenosis (MS)', 'outcomes after percutaneous balloon mitral valvuloplasty (PBMV)', 'gender or sex difference' and 'migration'. The reporting of this study conforms to SANRA (the Scale for Assessment of Narrative Review Articles) guidelines.

Results: We retrieved eight studies about the impact of sex on outcomes after PBMV. All of these studies showed a female predominance for RHD. Two studies showed that there is no impact, three studies showed female sex as a predictor of poor outcomes, and the other three showed male sex a predictor of poor outcomes. Although RHD is reported to be eradicated in the developed countries, 2.1% of refugees recently screened for RHD in Italy were found to have subclinical RHD. This prevalence is similar to those found in India (2.0%), Cambodia (2.2%) and Mozambique (3%).

Conclusions: There are contradicting results for outcomes after PBMV between males and females. It is not clear whether sex difference plays a role in pathophysiology, diagnosis, management and prognosis of MS. Migration has impacts on epidemiology and management of RHD. Further studies are required in these two fields to explore their relationship to RHD.

Keywords: gender; impact; migration; review; rheumatic mitral stenosis; sex.

Figure 1

Management of clinically significant mitral stenosis. ¹Thromboembolism: past embolism, atrial fibrillation, dense echo in left atrium; ²decompensation: pulmonary hypertension > 50 mmHg, major noncardiac operation, intention for pregnancy; ³Consider commissurotomy by experienced surgeons or in patients contraindicated for PBMV; ⁴Mitral valve orifice <1.5 cm², no left atrium clots, MR < grade 2, mild calcification, no fused commissures; ⁵PBMV for symptomatic patients contraindicated to operation, mitral valve operation for symptomatic patients unsuitable for PBMV; ⁶Surgery if symptomatic at less physical activity and low surgical risk. For the strength of recommendation: class I means the procedure should be performed, class IIa means it is reasonable to perform the procedure, and class IIb means the procedure may be considered (Redrawn from: Baumgartner et al ²¹ and Nishimura et al ²² 161 × 207mm (300 × 300 DPI)