リウマチ性心疾患の成人の死亡率と罹患率
Ganesan Karthikeyan1,2, Mpiko Ntsekhe3, Shofiqul Islam4
1Department of Cardiology, All India Institute of Medical Sciences, New Delhi.
JAMA
|June 5, 2024
まとめ
リウマチ性心疾患 (RHD) の死亡率は特に低所得国において高い. バルブ手術とバルブ整形手術は,RHDの死亡率を大幅に低下させ,これらの介入へのアクセスを改善する必要性を強調しています.
科学分野:
- 心臓病科
- 公衆衛生
- 流行病学について
背景:
- リウマチ性心臓病 (RHD) は,低・中所得国 (LMICs) の公衆衛生上の重大な問題である.
- 多数の流行国を含む大規模な研究は稀である.
研究 の 目的:
- RHD患者における主要な臨床結果のリスクと予測要因を決定する.
- 世界銀行 各国の所得層におけるイベント率を分析する.
主な方法:
- RHDに固有の24のLMICで138のサイトを対象とした多センター,前向きな観察研究.
- 2016年8月から2022年5月までの間に13,696人の患者の登録
- すべての原因による死亡率,特定の原因による死亡率,心不全の入院,脳卒中,再発性レウマチ熱,感染症性心内炎の分析.
主要な成果:
- 血管疾患,主に心不全が主な死因であった.
- 心不全や肺高血圧などの重症弁疾患のマーカーは死亡率を増加させ,弁手術や弁整形手術は死亡率を著しく低下させた.
- 国の所得水準が高くなるということは 患者レベルの要因を考慮した上で 死亡率が低いことと相関しています
結論:
- RHDの高い死亡率は,弁疾患の重症度に関連しています.
- バルブ手術とバルブ整形の手術へのアクセスは,RHDに関連する死亡率を減らすために不可欠です.
- 既存の予防措置に加えて 手術や介入ケアへのアクセスを強化する必要性を強調しています
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