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The high burden of rheumatic heart disease found on autopsy in Fiji
Pritinesh I P K Singh1, Jonathan R Carapetis, Eka M Buadromo
1Department of Pathology, Fiji Ministry of Health, Colonial War Memorial Hospital, Suva, Fiji Islands.
Insights
Rheumatic heart disease (RHD) is a major cause of death, particularly in developing nations. This study found RHD in 2.4% of autopsies, with deaths occurring at a young age, highlighting the need for better prevention.
Area of Science:
- Cardiology
- Pathology
- Public Health
Background:
- Rheumatic heart disease (RHD) is a significant global health issue, causing over 200,000 deaths annually, predominantly in developing countries.
- Autopsy studies on RHD in these high-burden regions are scarce, limiting understanding of its pathological prevalence and impact.
Purpose of the Study:
- To determine the prevalence and pathological characteristics of rheumatic heart disease (RHD) in Fiji through a retrospective autopsy review.
- To analyze mortality patterns, causes of death, and demographic factors associated with RHD in the study population.
Main Methods:
- Retrospective review of 6,218 autopsies conducted between 1990 and 2006.
- Macroscopic pathological examination of hearts to identify cases of rheumatic heart disease (RHD).
- Statistical analysis to determine prevalence, mortality, and risk factors, including ethnic comparisons.
Main Results:
- Rheumatic heart disease (RHD) was identified in 147 cases (2.4%) of the reviewed autopsies.
- Congestive cardiac failure was the primary cause of death in 75 cases directly attributable to RHD.
- The mean age at death from RHD was 38 years, with a higher prevalence observed in Indigenous Fijians compared to Indo-Fijians.
Conclusions:
- Rheumatic heart disease (RHD) represents a substantial burden in Fiji, contributing to premature mortality.
- Findings underscore the critical need for enhanced early detection strategies and effective secondary penicillin prophylaxis in Fiji and the broader Pacific region.
- The study highlights ethnic disparities in RHD prevalence, suggesting targeted public health interventions may be necessary.
Abstract:
Rheumatic heart disease causes more than 200,000 deaths worldwide annually, with the vast majority of these deaths occurring in developing countries, yet there are few autopsy studies of rheumatic heart disease in these countries. We performed a retrospective review of 6218 autopsies performed during the period from 1990 through 2006, searching for cases of rheumatic heart disease based upon the macroscopic pathologic examination of the heart. We found 147 cases (2.4%) of rheumatic heart disease. There was an apparent increase in the number of cases in the past 5 years. There were 95 deaths that were directly attributable to rheumatic heart disease, with congestive cardiac failure being the most common cause of death in 75 cases. The mean age at death due to rheumatic heart disease was 38 years. There were more cases of rheumatic heart disease in Indigenous Fijians than Indo-Fijians, with an adjusted relative risk of 1.26 (95% confidence intervals from 0.87 to 1.86). Our findings reflect the high burden and early age of death due to rheumatic heart disease in Fiji and the Pacific region generally, and underline the need for early detection and adequate secondary penicillin prophylaxis in this region.
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