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Related Concept Videos

Rheumatic Heart Disease III: Medical Management01:21

Rheumatic Heart Disease III: Medical Management

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Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
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The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
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AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...
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Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
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Clinical trials are prospective experimental studies conducted on humans to determine the safety and efficacy of treatments, drugs, diet methods, and medical devices. Using statistics in clinical trials enables researchers to derive reasonable and accurate conclusions from the collected data, allowing them to make wise decisions in uncertain situations. In medical research, statistical methods are crucial for preventing errors and bias.
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COVID-19 Vaccine Uptake, Hesitancy, and Flare in a Large Rheumatology Practice Network.

Emily E Holladay1, Amy S Mudano2, Fenglong Xie2

  • 1University of Alabama at Birmingham, Birmingham.

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COVID-19 vaccine uptake was high, but patients with autoimmune and inflammatory rheumatic diseases (AIIRDs) showed more hesitancy. Interventions are needed, as AIIRD patients were less likely to get vaccinated.

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Area of Science:

  • Rheumatology
  • Infectious Disease Epidemiology
  • Public Health

Background:

  • Understanding COVID-19 vaccine uptake and hesitancy is crucial, especially in patient populations with autoimmune and inflammatory rheumatic diseases (AIIRDs).
  • Previous studies have not fully elucidated vaccine hesitancy factors or self-reported disease flares in this specific demographic within a large rheumatology network.

Purpose of the Study:

  • To determine COVID-19 vaccine and booster uptake rates.
  • To identify reasons for vaccine and booster hesitancy among patients, particularly those with AIIRDs.
  • To assess the association between AIIRD status and self-reported disease flare post-vaccination.

Main Methods:

  • A tablet-based survey was administered across 108 rheumatology practices from December 2021 to December 2022.
  • Descriptive statistics and multivariable logistic regression were used to compare vaccination status, hesitancy, and flare between patients with and without AIIRDs.
  • Adjusted odds ratios (aORs) were calculated to examine associations.

Main Results:

  • 89% of 61,158 patients received at least one vaccine dose, with 68% receiving a booster.
  • Patients with AIIRDs exhibited higher vaccine (14% vs 10%) and booster hesitancy (21% vs 16%) compared to those without AIIRDs.
  • Safety concerns and side effects were primary reasons for vaccine hesitancy, while lack of physician recommendation drove booster hesitancy. Patients with AIIRDs were 32% less likely to receive a vaccine.
  • No increased odds of self-reported flare were observed in patients with AIIRDs (aOR 0.99).

Conclusions:

  • Despite high overall vaccine uptake, a significant proportion of patients, especially those with AIIRDs, expressed hesitancy.
  • A portion of hesitant individuals eventually received vaccination, suggesting potential efficacy of targeted interventions.
  • Future interventions should be tailored for patients with AIIRDs to improve vaccine and booster uptake.