- Email: [email protected]
PS276 Symptomatic Children With Post-Rheumatic Valvulopathies in Natural History: Five Years Follow-UP
POSTER ABSTRACTS
Methods: This was a cross-sectional investigation utilizing verbal and written surveys, nested in a school-based RHD prevalence study. Children and their parents were asked to report (a) number of sore throats in the previous 12 months; (b) treatment received; and (c) type and place of treatment. A focused history and physical examination to detect possible pharyngitis was done; if present, children were referred for follow-up. The study took place February-July 2015, was conducted in partnership with the Ministries of Health and Education, and received ethics approval from the University of Zambia. Results: A total of 2426 families participated from 35 Lusaka schools. Twenty percent of parents reported their child had at least one sore throat in the previous year, with 5% reporting three or more episodes. Twenty-three percent of children reported they had at least one sore throat in the previous year, with 5% reporting at least three. Nearly 15% of all children received treatment for pharyngitis in the previous year and 3% were reported to have received three or more separate treatments. The majority of treatments were received in government clinics (47%), followed by at home (36%), in a private clinic (10%), by a chemist/pharmacist (7%), and by a traditional healer (1%). Of those receiving treatment, an antibiotic was administered in 42%. Seventeen children were suspected to have pharyngitis at the time of screening and referred for follow-up. Conclusion: The regular occurrence of sore throats is well recognized but not all children receive treatment. An antibiotic is administered as component therapy in less than half of cases. These data should be considered in the context of previous reports that many patients with RHD do not recall previous episodes of pharyngitis. Disclosure of Interest: J. Musuku Grant/research support from: Novartis Institutes for BioMedical Research, J. Lungu: None Declared, E. Machila: None Declared, S. Schwaninger Employee from: Novartis Institutes for BioMedical Research, P. Musonda Grant/research support from: Novartis Institutes for BioMedical Research, M. Gutierrez Employee from: Novartis Institutes for BioMedical Research, B. Tadmor Employee from: Novartis Institutes for BioMedical Research, J. Spector Employee from: Novartis Institutes for BioMedical Research PS273 Cardiac Echinococcosis, Clinical Presentation, Diagnosis and Surgical Treatment V. Ivanov*1, on behalf of Ivanova L.N., Nikityuk T.G. 1 Cadio-Surgery, Petrovsky National Reseach Center of Surgery, Moscow, Russian Federation Introduction: Echinococcosis is an extremely rare disease caused by the larval cestode Echinococcus granulosus. Dogs are the definitive hosts for E. granulosus, and sheep are the major intermediate hosts, humans are only accidental hosts when they ingest food or water that is fecally contaminated with eggs. Cardiac hydatid cysts are found in fewer than 3% of cases of hydatidosis. In clinical presentation of cardiac echinococcosis (CE) there is no pathognomonic sign. Objectives: The aim of the study was to demonstrate difficulties of diagnostics and options of surgical treatment of cardiac echinococcosis. Methods: 6 patients - 4 men and 2 women, aged 20 to 60 years were studied and treated. The clinical manifestations of CE are non-specific. The disease often resembles coronary heart disease, and ECG shows signs of myocardial infarction. Diagnosis of CE was made using radiography, echocardiography, CT, coupled with serological tests. Isolated cardiac echinococcosis was diagnosed in 3 patients. Three other patients had cysts beside the heart located in the brain; lung and liver; and in the gluteal region. Results: All patients were successfully surgically treated on cardiopulmonary bypass. Conclusion: Rare localization of hydatid cysts in the heart characterizes an aggressive parasite and indicates its atypical morphology. The accuracy of the diagnosis of CE is possible combining the echocardiogram, CT scan and serology studies. Due to the high risk of rupture of the altered myocardium the only reasonable option of treatment is surgery with cardiopulmonary bypass. Surgical tactics in each case requires an individual approach. Treatment of patients with CE should be comprehensive and should include postoperative antiparasitic chemotherapy. Disclosure of Interest: None Declared PS274 Community Based Study in the Utility of the Components of Jones Criteria in the Diagnosis of Rheumatic Fever E. F. M. Portigo*1 1 Pediatric Cardiology, Philippine Heart Center, Quezon City, Philippines Introduction: Acute Rheumatic Fever is a common and serious public health problem in developing countries such as the Philippines in which rheumatic heart disease is an important complication. Mostly of the affected individual go unnoticed, without symptoms at all, until they presented with severe cardiac sequela. Although rheumatic fever is a systemic disease with multiorgan involvement, only carditis lead to permanent damage. Objectives: This paper aims to determine the prevalence rate of Rheumatic Fever and the components of Jones Criteria in a Community. Methods: A total of 120 students from Flora Ylagan National High School in Quezon City participated in this study. A signed consent and assent forms were obtained prior to the study. There were 77 females and 44 males ages 9 to 17 years old with median age of 13.39
e60
years. History and Physical examination were done prior to blood extraction and 2D echocardiography. Results: Joint pains and sorethroat were the most common manifestations. Majority of the students did not have history of fever and rashes, while 15% had sorethroat, and 9.16% had joint pains. Laboratory data showed that 9.16% had positive results for CRP while 53% had elevated ASO titer. ECG findings were normal. 2.5% met the Jones Criteria for Rheumatic Fever. While 22.5% showed carditis by echocardiography based on the modified criteria by WHO. On 2D echocardiograpghy, 22.5% had mitral regurgitation jet of > 1cm in length, 667% had mitral regurgitation velocity >3m/sec for 1 complete envelope, 23.33% had mitral regurgitation pansystolic jet in at least 1 envelope, and 56.67% had anterior mitral valve thickening of > 3mm. All students had normal aortic valve an absence of mitral stenosis. Conclusion: The prevalence of Rheumatic Fever in a community is evident in the presence of carditis by echocardiography in persons presenting with no symptoms at all, called subclinical carditis. Thus early detection of rheumatic carditis through echo is very helpful as a screening tool in the diagnosis of Rheumatic Fever, thereby medical management can be instituted early as primary and secondary prophylaxis. As these children with carditis remain asymptomatic, clinicians should have a high index of suspicion and that the need for echocardiography should be considered as a screening tool in a community. Disclosure of Interest: None Declared PS275 Undiagnosed Rheumatic Fever: The Submerged Part of The Iceberg A. Bouzid*1, S. Chibane1, S. Bouchenafa1, R. A. Ould Abderrahmane1 1 Cardiac Surgery, EHU 1er Novembre 54, Oran, Algeria Introduction: In Algeria prevalence of rheumatic fever(RF) has steadily decrease especially after the establishment of the national program against the RF in 1990; the national incidence decreased from 04.7 / 100,000 in 2002 to 02.5 / 100,000 in 2003, 02.3 / 100,000 in 2004, in 2009 the national incidence decreased to 1.01cas / 100,000 of 04 to 19 years. However, the share of rheumatic patients requiring surgical treatment for valvular lesions has not changed, indicating the insufficiency of the modified Jones criteria. Objectives: To evaluate the sensitivity of the Jones criteria for the diagnosis of rheumatic fever in patients with rheumatic valve disease. Methods: 166 patients were operated for pure rheumatic mitral stenosis with or without aortic lesions, from January 2013 to September 2015 at the cardiac surgery department of the EHU 1 November 54. The sex ratio was 0.52; the mean age was 46.37 years, 95% CI [44.68 – 48.05]. Rheumatic lesion was confirmed by pure or predominant stenotic lesion of the mitral valve. Results: Only 13 patients of the 166 patients (07.8%) had a history of rheumatic fever diagnosed and treated; the remaining 153 patients (92.2%) have never been diagnosed or treated for rheumatic fever, until the appearance of valvular lesions which indicated surgery. The quarter of the patients were from urban zones, 70% of patients with ARF history was from rural zone. Conclusion: Despite the favorable results of the national program against the RF; However cardiac surgery departments are still receiving patients with valvular rheumatic lesions, which have never been diagnosed or treated, this testifies to the insufficiency of Jones criteria for the diagnosis of rheumatic fever, other criteria must be introduced for the diagnosis (echocardiography, biological); the aim being to reduce the socio-economic impact of this disease, and why not eradicate definitively rheumatic fever. Disclosure of Interest: None Declared PS276 Symptomatic Children With Post-Rheumatic Valvulopathies in Natural History: Five Years Follow-UP T. T. J. Cabral*1, A. Jean Claude1, B. Gianfranco2 1 Cardiology, Cardiac Centre shisong, Kumbo, Cameroon, 2Cardiology, Policlinico San Donato IRCCS, Milan, Italy Introduction: Rheumatic heart disease is the most important sequelae of acute rheumatic fever, which is caused by group A streptococci and usually presents in childhood, affecting 5 to 14 years old although it can strike people up to the age of 30. In poor and developing nations, it remains a major cause of morbidity and premature death, imposing a substantial burden on healthcare systems with limited budgets. Objectives: The aim of the study was to investigate the pattern of valvular lesions, the mortality and the challenges in five years follow-up in symptomatic children with post rheumatic valvulopathies in natural history in St. Elizabeth Catholic General hospital, cardiac centre. Methods: In the study were recruited 95 symptomatic children. ransthoracic echocardiography was performed using commercially available echocardiography equipment (Acuson Sequoia, Acuson Co, Mountain View USA) with a 3,5 MHz transducer. Left ventricular systolic performance was assessed by determination of the ejection fraction, the left ventricular systolic and diastolic volumes. The regurgitation was quantified using the vena contracta and the regurgitation area. The TAPSE was also measured.
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS
Results: Two-thirds (64%) of all patients <50 years old had RHD. These patients were younger (26 vs. 33 years, p<0.001) and more often female (69% vs. 59%, p¼0.002) than non-RHD patients. Patients of Nilote ethnicity had over twice the odds of RHD than non-Nilotes (OR 2.5, 95%CI 1.7-3.7). We observed global clustering of disease rates within 200km of the hospital with significant clustering of the rate difference between RHD and non-RHD rates surrounding the hospital (Moran’s I: 0.3, p¼0.001) (Figure). This clustering was attenuated after controlling for age, gender, ethnicity and distance from the hospital. There was an interaction between ethnicity and distance to the hospital such that odds of RHD increased with further distance from the hospital for Nilotes, but the odds of RHD in non-Nilotes decreased with further distance.
PS277 A Review of Patient Perceived Barriers and Enablers of Adherence to Secondary Prophylaxis Medication for Rheumatic Heart Disease in the Fiji Islands S. Colquhoun*1, C. Read2, B. Ward3, R. Taito4, L. Matatolu5, F. Matanatabu5, M. Ah Kee5, S. La Vincente1, J. Kado6, A. Steer7 1 Centre for International Child Health, Murdoch Childrens Research Institute, Parkville, Melbourne, 2Telethon Kids Institute, University of Western Australia, Perth, 3Murdoch Childrens Research Institute, Murdoch Childrens Research Institute, Parkville, Melbourne, Australia, 4 Lautoka Hospital, Fiji Ministry of Health and Medical Services, Lautoka, 5Fiji GrASP, Ministry of Health and Medical Services, 6College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji, 7Group A Streptococcal Research Group, Murdoch Childrens Research Inistitute, Parkville, Melbourne, Australia Introduction: Secondary prophylaxis for Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD) is the mainstay of ARF and RHD control programmes. Despite the availability, affordability and importance of maintaining protective levels of secondary prophylaxis, adherence remains low. Adherence data collected in Fiji in 2013-14 showed that less than half of patients requiring BPG received >80% of their scheduled injections. Objectives: This study aims to examine perceptions and reasons contributing to both poor and good adherence to secondary prophylaxis from the perspective of people living with ARF/RHD. Methods: Fifty-two patients receiving BPG, or their parent/guardian, were approached for consent to engage in semi-structured interviews. Twenty-three participants had a history of good adherence to Benzathine penicillin G (defined as cases receiving 80% or more of their scheduled injections annually) and 29 had a history of poor adherence over the past two years (receiving less than 50% of their scheduled injections). Data was recorded, transcribed and analyzed by means of thematic analysis to draw common themes from the data. Results: Six themes emerged from the data and highlighted major sources of barriers and enablers to BPG adherence. General understanding of the disease and reason BPG injections were required was low amongst both adherent and non-adherent respondents. Access to healthcare, including affordability of transport to a health centre, physical accessibility, acceptability and availability of services were major barriers to adherence. Supply of BPG was a key factor affecting adherence mainly for non-adherent patients, and discomfort of injections was a common theme across both groups. Interruption to adherence was common among the five enrolled participants who were pregnant. Conclusion: These findings, the first of their kind from the Pacific region, give insight into the factors affecting BPG adherence among patients. Recommendations from the study will contribute to prevention, management and policy implication for the Fiji RHD Control programme. Disclosure of Interest: None Declared PS278 Geographic and Demographic Patterns of Rheumatic Heart Disease in Western Kenya R. Lumsden1, C. Akwanalo2, W. P. O’Meara3,4, G. S. Bloomfield*3,5 1 School of Medicine, University of Massachusetts Medical School, Worcester, United States, 2 Division of Medicine, Moi Teaching and Referral Hospital, Eldoret, Kenya, 3Duke Global Health Institute, 4Department of Infectious Diseases, 5Department of Medicine, Division of Cardiology, Duke University, Durham, United States Introduction: Rheumatic heart disease (RHD) remains a leading cause of cardiovascular mortality in sub-Saharan Africa. Geography and ethnicity are thought to influence the odds of developing RHD. Identifying geographic hot spots and high risk populations are crucial for the development of future RHD prevention and screening strategies in high burden areas. Objectives: We aimed to identify demographic patterns and geographic variation in RHD prevalence in western Kenya. Methods: We conducted a retrospective chart review of all patients <50 years old (n¼937) attending adult cardiology clinic at a national referral hospital in western Kenya. Demographic information, residential location and cardiac history were collected. We mapped the spatial distribution of cardiac disease rates and analyzed the effect of distance from the hospital on RHD status using multivariable logistic regression.
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS
Conclusion: Most adult cardiology patients at a national referral hospital in western Kenya have RHD, indicating that RHD is a significant cardiovascular burden in western Kenya. Young females of Nilote ethnicity are commonly affected. Ethnicity and distance to the hospital interdependently affect the odds of RHD. Geographic clustering of disease rates may be influenced by spatial clustering of ethnic groups given this relationship. Future studies in this area should consider the impact of ethnic predisposition to RHD. Disclosure of Interest: None Declared
PS279 Prevalence of Rheumatic Heart Disease in the Pacific: From Subclincial to Symptomatic Disease M. Mirabel*1,2, M. Tafflet1, B. Noël3, T. Parks4, C. Braunstein3, B. Rouchon5, E. Marijon1,6, X. Jouven1,6 1 Institut National de la Santé et de la Recherche Médicale, 2Cardiology, Hôpital Européen Georges Pompidou, Paris, France, 3Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia, 4Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom, 5Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia, 6Hôpital Européen Georges Pompidou, Paris, France Introduction: The advent of echocardiographic screening in endemic areas for rheumatic heart disease (RHD) has led to a new epidemiological pyramid-type model combining asymptomatic subclinical RHD at the base and severe RHD leading to hospital admission at the top. Objectives: To provide population and hospital-based epidemiological data to support this hypothesis. Methods: Two independent studies were conducted assessing prevalence of subclinical RHD in schoolchildren, and of symptomatic RHD requiring hospital admission in New Caledonia. The population-based prevalence was based on systematic echocardiography screening targeting all 4th graders in the country (2008-2011). A retrospective review of all hospital charts of patients identified through ICD acute rheumatic fever or RHD codes following admission at the only hospital (2008-2011). The exact prevalence (95% CI) of RHD was computed. The New Caledonian Bureau of Statistics population estimates published in 2009 were used for population denominators.
e61
POSTER ABSTRACTS
Results: In 95 symptomatic patients aged between 5 and 16 years old with a mean age of 12,4 4,5 years surgical correction could not be performed. Mitral regurgitation was the commonest echocardiographic diagnosis present in 51,7% patients; 13,3% patients had mixed mitral valve disease, 35% had pure mitral stenosis. Pulmonary hypertension was the common echocardiographic complication of the disease in 87% of cases. Clinically, complications of the disease included, congestive heart failure, fatigue, growth retardation, sudden death. On presentation, 78% of cases were admitted. Mortality in two years was 55%, in five years was 75%. The challenges faced are patients’negligence and poor discipline, wrong beliefs, poverty. Conclusion: Post rheumatic mitral valve regurgitation is the pathology the most encountered. Pulmonary hypertension is the most common echocardiographic complication of the disease. Five years mortality is very high in our setting. Due to financial limitation poverty and illiteracy of parents, the follow up of patients is difficult. Disclosure of Interest: None Declared
Methods: This was a cross-sectional investigation utilizing verbal and written surveys, nested in a school-based RHD prevalence study. Children and their parents were asked to report (a) number of sore throats in the previous 12 months; (b) treatment received; and (c) type and place of treatment. A focused history and physical examination to detect possible pharyngitis was done; if present, children were referred for follow-up. The study took place February-July 2015, was conducted in partnership with the Ministries of Health and Education, and received ethics approval from the University of Zambia. Results: A total of 2426 families participated from 35 Lusaka schools. Twenty percent of parents reported their child had at least one sore throat in the previous year, with 5% reporting three or more episodes. Twenty-three percent of children reported they had at least one sore throat in the previous year, with 5% reporting at least three. Nearly 15% of all children received treatment for pharyngitis in the previous year and 3% were reported to have received three or more separate treatments. The majority of treatments were received in government clinics (47%), followed by at home (36%), in a private clinic (10%), by a chemist/pharmacist (7%), and by a traditional healer (1%). Of those receiving treatment, an antibiotic was administered in 42%. Seventeen children were suspected to have pharyngitis at the time of screening and referred for follow-up. Conclusion: The regular occurrence of sore throats is well recognized but not all children receive treatment. An antibiotic is administered as component therapy in less than half of cases. These data should be considered in the context of previous reports that many patients with RHD do not recall previous episodes of pharyngitis. Disclosure of Interest: J. Musuku Grant/research support from: Novartis Institutes for BioMedical Research, J. Lungu: None Declared, E. Machila: None Declared, S. Schwaninger Employee from: Novartis Institutes for BioMedical Research, P. Musonda Grant/research support from: Novartis Institutes for BioMedical Research, M. Gutierrez Employee from: Novartis Institutes for BioMedical Research, B. Tadmor Employee from: Novartis Institutes for BioMedical Research, J. Spector Employee from: Novartis Institutes for BioMedical Research PS273 Cardiac Echinococcosis, Clinical Presentation, Diagnosis and Surgical Treatment V. Ivanov*1, on behalf of Ivanova L.N., Nikityuk T.G. 1 Cadio-Surgery, Petrovsky National Reseach Center of Surgery, Moscow, Russian Federation Introduction: Echinococcosis is an extremely rare disease caused by the larval cestode Echinococcus granulosus. Dogs are the definitive hosts for E. granulosus, and sheep are the major intermediate hosts, humans are only accidental hosts when they ingest food or water that is fecally contaminated with eggs. Cardiac hydatid cysts are found in fewer than 3% of cases of hydatidosis. In clinical presentation of cardiac echinococcosis (CE) there is no pathognomonic sign. Objectives: The aim of the study was to demonstrate difficulties of diagnostics and options of surgical treatment of cardiac echinococcosis. Methods: 6 patients - 4 men and 2 women, aged 20 to 60 years were studied and treated. The clinical manifestations of CE are non-specific. The disease often resembles coronary heart disease, and ECG shows signs of myocardial infarction. Diagnosis of CE was made using radiography, echocardiography, CT, coupled with serological tests. Isolated cardiac echinococcosis was diagnosed in 3 patients. Three other patients had cysts beside the heart located in the brain; lung and liver; and in the gluteal region. Results: All patients were successfully surgically treated on cardiopulmonary bypass. Conclusion: Rare localization of hydatid cysts in the heart characterizes an aggressive parasite and indicates its atypical morphology. The accuracy of the diagnosis of CE is possible combining the echocardiogram, CT scan and serology studies. Due to the high risk of rupture of the altered myocardium the only reasonable option of treatment is surgery with cardiopulmonary bypass. Surgical tactics in each case requires an individual approach. Treatment of patients with CE should be comprehensive and should include postoperative antiparasitic chemotherapy. Disclosure of Interest: None Declared PS274 Community Based Study in the Utility of the Components of Jones Criteria in the Diagnosis of Rheumatic Fever E. F. M. Portigo*1 1 Pediatric Cardiology, Philippine Heart Center, Quezon City, Philippines Introduction: Acute Rheumatic Fever is a common and serious public health problem in developing countries such as the Philippines in which rheumatic heart disease is an important complication. Mostly of the affected individual go unnoticed, without symptoms at all, until they presented with severe cardiac sequela. Although rheumatic fever is a systemic disease with multiorgan involvement, only carditis lead to permanent damage. Objectives: This paper aims to determine the prevalence rate of Rheumatic Fever and the components of Jones Criteria in a Community. Methods: A total of 120 students from Flora Ylagan National High School in Quezon City participated in this study. A signed consent and assent forms were obtained prior to the study. There were 77 females and 44 males ages 9 to 17 years old with median age of 13.39
e60
years. History and Physical examination were done prior to blood extraction and 2D echocardiography. Results: Joint pains and sorethroat were the most common manifestations. Majority of the students did not have history of fever and rashes, while 15% had sorethroat, and 9.16% had joint pains. Laboratory data showed that 9.16% had positive results for CRP while 53% had elevated ASO titer. ECG findings were normal. 2.5% met the Jones Criteria for Rheumatic Fever. While 22.5% showed carditis by echocardiography based on the modified criteria by WHO. On 2D echocardiograpghy, 22.5% had mitral regurgitation jet of > 1cm in length, 667% had mitral regurgitation velocity >3m/sec for 1 complete envelope, 23.33% had mitral regurgitation pansystolic jet in at least 1 envelope, and 56.67% had anterior mitral valve thickening of > 3mm. All students had normal aortic valve an absence of mitral stenosis. Conclusion: The prevalence of Rheumatic Fever in a community is evident in the presence of carditis by echocardiography in persons presenting with no symptoms at all, called subclinical carditis. Thus early detection of rheumatic carditis through echo is very helpful as a screening tool in the diagnosis of Rheumatic Fever, thereby medical management can be instituted early as primary and secondary prophylaxis. As these children with carditis remain asymptomatic, clinicians should have a high index of suspicion and that the need for echocardiography should be considered as a screening tool in a community. Disclosure of Interest: None Declared PS275 Undiagnosed Rheumatic Fever: The Submerged Part of The Iceberg A. Bouzid*1, S. Chibane1, S. Bouchenafa1, R. A. Ould Abderrahmane1 1 Cardiac Surgery, EHU 1er Novembre 54, Oran, Algeria Introduction: In Algeria prevalence of rheumatic fever(RF) has steadily decrease especially after the establishment of the national program against the RF in 1990; the national incidence decreased from 04.7 / 100,000 in 2002 to 02.5 / 100,000 in 2003, 02.3 / 100,000 in 2004, in 2009 the national incidence decreased to 1.01cas / 100,000 of 04 to 19 years. However, the share of rheumatic patients requiring surgical treatment for valvular lesions has not changed, indicating the insufficiency of the modified Jones criteria. Objectives: To evaluate the sensitivity of the Jones criteria for the diagnosis of rheumatic fever in patients with rheumatic valve disease. Methods: 166 patients were operated for pure rheumatic mitral stenosis with or without aortic lesions, from January 2013 to September 2015 at the cardiac surgery department of the EHU 1 November 54. The sex ratio was 0.52; the mean age was 46.37 years, 95% CI [44.68 – 48.05]. Rheumatic lesion was confirmed by pure or predominant stenotic lesion of the mitral valve. Results: Only 13 patients of the 166 patients (07.8%) had a history of rheumatic fever diagnosed and treated; the remaining 153 patients (92.2%) have never been diagnosed or treated for rheumatic fever, until the appearance of valvular lesions which indicated surgery. The quarter of the patients were from urban zones, 70% of patients with ARF history was from rural zone. Conclusion: Despite the favorable results of the national program against the RF; However cardiac surgery departments are still receiving patients with valvular rheumatic lesions, which have never been diagnosed or treated, this testifies to the insufficiency of Jones criteria for the diagnosis of rheumatic fever, other criteria must be introduced for the diagnosis (echocardiography, biological); the aim being to reduce the socio-economic impact of this disease, and why not eradicate definitively rheumatic fever. Disclosure of Interest: None Declared PS276 Symptomatic Children With Post-Rheumatic Valvulopathies in Natural History: Five Years Follow-UP T. T. J. Cabral*1, A. Jean Claude1, B. Gianfranco2 1 Cardiology, Cardiac Centre shisong, Kumbo, Cameroon, 2Cardiology, Policlinico San Donato IRCCS, Milan, Italy Introduction: Rheumatic heart disease is the most important sequelae of acute rheumatic fever, which is caused by group A streptococci and usually presents in childhood, affecting 5 to 14 years old although it can strike people up to the age of 30. In poor and developing nations, it remains a major cause of morbidity and premature death, imposing a substantial burden on healthcare systems with limited budgets. Objectives: The aim of the study was to investigate the pattern of valvular lesions, the mortality and the challenges in five years follow-up in symptomatic children with post rheumatic valvulopathies in natural history in St. Elizabeth Catholic General hospital, cardiac centre. Methods: In the study were recruited 95 symptomatic children. ransthoracic echocardiography was performed using commercially available echocardiography equipment (Acuson Sequoia, Acuson Co, Mountain View USA) with a 3,5 MHz transducer. Left ventricular systolic performance was assessed by determination of the ejection fraction, the left ventricular systolic and diastolic volumes. The regurgitation was quantified using the vena contracta and the regurgitation area. The TAPSE was also measured.
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS
Results: Two-thirds (64%) of all patients <50 years old had RHD. These patients were younger (26 vs. 33 years, p<0.001) and more often female (69% vs. 59%, p¼0.002) than non-RHD patients. Patients of Nilote ethnicity had over twice the odds of RHD than non-Nilotes (OR 2.5, 95%CI 1.7-3.7). We observed global clustering of disease rates within 200km of the hospital with significant clustering of the rate difference between RHD and non-RHD rates surrounding the hospital (Moran’s I: 0.3, p¼0.001) (Figure). This clustering was attenuated after controlling for age, gender, ethnicity and distance from the hospital. There was an interaction between ethnicity and distance to the hospital such that odds of RHD increased with further distance from the hospital for Nilotes, but the odds of RHD in non-Nilotes decreased with further distance.
PS277 A Review of Patient Perceived Barriers and Enablers of Adherence to Secondary Prophylaxis Medication for Rheumatic Heart Disease in the Fiji Islands S. Colquhoun*1, C. Read2, B. Ward3, R. Taito4, L. Matatolu5, F. Matanatabu5, M. Ah Kee5, S. La Vincente1, J. Kado6, A. Steer7 1 Centre for International Child Health, Murdoch Childrens Research Institute, Parkville, Melbourne, 2Telethon Kids Institute, University of Western Australia, Perth, 3Murdoch Childrens Research Institute, Murdoch Childrens Research Institute, Parkville, Melbourne, Australia, 4 Lautoka Hospital, Fiji Ministry of Health and Medical Services, Lautoka, 5Fiji GrASP, Ministry of Health and Medical Services, 6College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji, 7Group A Streptococcal Research Group, Murdoch Childrens Research Inistitute, Parkville, Melbourne, Australia Introduction: Secondary prophylaxis for Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD) is the mainstay of ARF and RHD control programmes. Despite the availability, affordability and importance of maintaining protective levels of secondary prophylaxis, adherence remains low. Adherence data collected in Fiji in 2013-14 showed that less than half of patients requiring BPG received >80% of their scheduled injections. Objectives: This study aims to examine perceptions and reasons contributing to both poor and good adherence to secondary prophylaxis from the perspective of people living with ARF/RHD. Methods: Fifty-two patients receiving BPG, or their parent/guardian, were approached for consent to engage in semi-structured interviews. Twenty-three participants had a history of good adherence to Benzathine penicillin G (defined as cases receiving 80% or more of their scheduled injections annually) and 29 had a history of poor adherence over the past two years (receiving less than 50% of their scheduled injections). Data was recorded, transcribed and analyzed by means of thematic analysis to draw common themes from the data. Results: Six themes emerged from the data and highlighted major sources of barriers and enablers to BPG adherence. General understanding of the disease and reason BPG injections were required was low amongst both adherent and non-adherent respondents. Access to healthcare, including affordability of transport to a health centre, physical accessibility, acceptability and availability of services were major barriers to adherence. Supply of BPG was a key factor affecting adherence mainly for non-adherent patients, and discomfort of injections was a common theme across both groups. Interruption to adherence was common among the five enrolled participants who were pregnant. Conclusion: These findings, the first of their kind from the Pacific region, give insight into the factors affecting BPG adherence among patients. Recommendations from the study will contribute to prevention, management and policy implication for the Fiji RHD Control programme. Disclosure of Interest: None Declared PS278 Geographic and Demographic Patterns of Rheumatic Heart Disease in Western Kenya R. Lumsden1, C. Akwanalo2, W. P. O’Meara3,4, G. S. Bloomfield*3,5 1 School of Medicine, University of Massachusetts Medical School, Worcester, United States, 2 Division of Medicine, Moi Teaching and Referral Hospital, Eldoret, Kenya, 3Duke Global Health Institute, 4Department of Infectious Diseases, 5Department of Medicine, Division of Cardiology, Duke University, Durham, United States Introduction: Rheumatic heart disease (RHD) remains a leading cause of cardiovascular mortality in sub-Saharan Africa. Geography and ethnicity are thought to influence the odds of developing RHD. Identifying geographic hot spots and high risk populations are crucial for the development of future RHD prevention and screening strategies in high burden areas. Objectives: We aimed to identify demographic patterns and geographic variation in RHD prevalence in western Kenya. Methods: We conducted a retrospective chart review of all patients <50 years old (n¼937) attending adult cardiology clinic at a national referral hospital in western Kenya. Demographic information, residential location and cardiac history were collected. We mapped the spatial distribution of cardiac disease rates and analyzed the effect of distance from the hospital on RHD status using multivariable logistic regression.
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS
Conclusion: Most adult cardiology patients at a national referral hospital in western Kenya have RHD, indicating that RHD is a significant cardiovascular burden in western Kenya. Young females of Nilote ethnicity are commonly affected. Ethnicity and distance to the hospital interdependently affect the odds of RHD. Geographic clustering of disease rates may be influenced by spatial clustering of ethnic groups given this relationship. Future studies in this area should consider the impact of ethnic predisposition to RHD. Disclosure of Interest: None Declared
PS279 Prevalence of Rheumatic Heart Disease in the Pacific: From Subclincial to Symptomatic Disease M. Mirabel*1,2, M. Tafflet1, B. Noël3, T. Parks4, C. Braunstein3, B. Rouchon5, E. Marijon1,6, X. Jouven1,6 1 Institut National de la Santé et de la Recherche Médicale, 2Cardiology, Hôpital Européen Georges Pompidou, Paris, France, 3Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia, 4Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom, 5Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia, 6Hôpital Européen Georges Pompidou, Paris, France Introduction: The advent of echocardiographic screening in endemic areas for rheumatic heart disease (RHD) has led to a new epidemiological pyramid-type model combining asymptomatic subclinical RHD at the base and severe RHD leading to hospital admission at the top. Objectives: To provide population and hospital-based epidemiological data to support this hypothesis. Methods: Two independent studies were conducted assessing prevalence of subclinical RHD in schoolchildren, and of symptomatic RHD requiring hospital admission in New Caledonia. The population-based prevalence was based on systematic echocardiography screening targeting all 4th graders in the country (2008-2011). A retrospective review of all hospital charts of patients identified through ICD acute rheumatic fever or RHD codes following admission at the only hospital (2008-2011). The exact prevalence (95% CI) of RHD was computed. The New Caledonian Bureau of Statistics population estimates published in 2009 were used for population denominators.
e61
POSTER ABSTRACTS
Results: In 95 symptomatic patients aged between 5 and 16 years old with a mean age of 12,4 4,5 years surgical correction could not be performed. Mitral regurgitation was the commonest echocardiographic diagnosis present in 51,7% patients; 13,3% patients had mixed mitral valve disease, 35% had pure mitral stenosis. Pulmonary hypertension was the common echocardiographic complication of the disease in 87% of cases. Clinically, complications of the disease included, congestive heart failure, fatigue, growth retardation, sudden death. On presentation, 78% of cases were admitted. Mortality in two years was 55%, in five years was 75%. The challenges faced are patients’negligence and poor discipline, wrong beliefs, poverty. Conclusion: Post rheumatic mitral valve regurgitation is the pathology the most encountered. Pulmonary hypertension is the most common echocardiographic complication of the disease. Five years mortality is very high in our setting. Due to financial limitation poverty and illiteracy of parents, the follow up of patients is difficult. Disclosure of Interest: None Declared