Rheumatic Fever Prophylactic Programme: analysis of the pattern of presentation and evolution after the control of recurrences

  • Prof Cleonice Mota, Division of Paediatric and Foetal Cardiology/Department of Paediatrics/Hospital das Clínicas-Federal University of Minas Gerais, Brazil
  • Prof Zilda Meira, Division of Paediatric and Foetal Cardiology/Department of Paediatrics/Hospital das Clínicas-Federal University of Minas Gerais, Brazil
  • Dr Fátima Rocha, Division of Paediatric and Foetal Cardiology/Department of Paediatrics/Hospital das Clínicas-Federal University of Minas Gerais, Brazil

    • Objective- To compare the profile of clinical presentation and evolution in control patients before and after the implementation of the Prophylactic Programme.

    Methods- Comparative study involving 702 children and adolescents with rheumatic fever, covering the periods 07/77-07/88 (Group I) and 08/88-02/00 (Group II). The following variables were analysed: age at first episode, affected joints, classification of valvar lesion,recurrences, degree of carditis, besides frequency of stenotic valvar lesions, surgeries, hospital admissions and deaths.

    Results- The age ranged from 2.7 to 19.9 years. Carditis (69,7%) and arthritis (70,4%) were seen most frequently. There was no difference regarding gender, except for chorea (p=0,001). The comparative analysis of the clinical/epidemiological data and pattern of severity are showed in Table 1.

    Conclusion- After the implementation of the programme, the clinical presentation remained unchanged, however, there were significant differences in the pattern of severity, especially in the frequency of hospital admissions, surgeries and deaths, due to the healthcare team’s action to control recurrences.

    Clinical/epidemio data Pattern of severity Group 1 (n=248) Group 2 ( n=454) p
    Age at first attack: mean /median (years) 8.8±5.5/ 8.8 9.4±3.1/ 9.0 NS
    Large/small joints%) 86.7/13.3 84.5/15.5 NS
    MR+AR+MS/ other associations(%) 94.2/5.8 95.6/4.4 NS
    Recurrences (%) 22.4 7.4 < 0.001
    Severe/mild carditis(%) 49.8/15.7 30.1/30.6 < 0.001
    Hospital admissions(% 45.4 9.1 < 0.001
    Surgeries(%) 13.3 1.5 < 0.001
    Deaths(%) 5.4 1.6 < 0.001