Figure 1
Flow diagram of the scoping review process. The diagram illustrates the identification, screening, eligibility assessment, inclusion, and exclusion of studies on rheumatic heart disease in Europe, following the PRISMA framework. Numbers of records at each stage are indicated, highlighting reasons for exclusion and the final set of included studies.
Table 1
Demographic and clinical characteristics of the screened population and participants from our pilot study with echocardiographic abnormalities warranting confirmatory echocardiography.
| CHARACTERISTIC | TOTAL POPULATION (n = 150) | ECHOCARDIOGRAPHIC ABNORMALITIES (n = 10) |
|---|---|---|
| Sex | Male: 59.3% (89) Female: 40.7% (61) | Male: 80% (8) Female: 20% (2) |
| Age (years) | Median: 20 (Range 5–26) Median Asia: 20.2 Median Africa: 20.6 | Median: 24 (Range 19–26) |
| Origin | Africa: 54% (81) Asia: 46% (69) | Africa: 60% (6) Asia: 40% (4) |
| Highest Education | No schooling: 6 (Median age 9.5) Primary: 34 (Median age 13.5) Secondary: 50 (Median age 23) High school: 43 (Median age 23) University: 16 (Median age 25) | No schooling: 0 Primary: 1 (22) Secondary: 2 (19, 26) High school: 4 (23, 24, 25, 25) University: 3 (22, 25, 26) |
| Housing Conditions | Multiple rooms + water + electricity: 83 1 room + water + electricity: 24 Electricity only: 12 Water only: 17 None: 13 | Multiple rooms + water + electricity: 6 1 room + water + electricity: 1 Electricity only: 2 Water only: 1 None: 0 |
| Previous RHD-Associated Conditions | Rheumatic fever: 3.3% Cardiac issues: 14% Chorea: 5.3% Skin rash: 6% Joint problems: 30.7% | Rheumatic fever: 0% Cardiac issues: 10% (1/10) Chorea: 0% Skin rash: 30% (3/10) Joint problems: 50% (5/10) |
| Echocardiographic Findings | Not applicable | Mitral Regurgitation > 2 cm: 9/10 Aortic Regurgitation: 1/10 |
Table 2
Selected key publications from the scoping review on rheumatic heart disease in Europe. These studies were chosen based on their relevance to the RHED-MIG study objectives, including epidemiology, clinical characteristics, diagnostics, and insights into high-risk populations
| REFERENCE ID | TITLE | AUTHOR/YEAR | STUDY TYPE | POPULATION/COUNTRY | METHOD | CONCLUSION |
|---|---|---|---|---|---|---|
| https://doi.org/10.2459/JCM.0000000000000228 | Heart surgery for immigrants in Italy: burden of cardiovascular disease, adherence to treatment and outcomes | Grimaldi et al. 2016 | prospective/observational | Migrants needing heart surgery in Italy | A clinical and echocardiographic survey was conducted on 154 consecutive immigrants referred for heart surgery to San Raffaele Hospital in Milan between 2003 and 2011. | The major cause of heart disease was RHD (41%). Cardiovascular diseases represent a major health topic among immigrants in developed countries. RHD still is the predominant cause of hospitalization for heart surgery, with nonrheumatic valvulopathies and IHD being the second and third causes, respectively. The data underlines the need to reinforce prevention and care strategies in the matter of immigrant health and warrants the urgent attention of the international public health and research communities. |
| https://doi.org/10.5543/tkda.2013.71430 | The Turkish registry of heart valve disease | Demirbag et al. 2013 | prospective | Patients with VHD admitted to the cardiology clinics in 33 cities from seven geographical regions in Turkey were included in the study | Informed Data was collected via the internet from each hospital. The dataset comprised around 200 different parameters, such as demographical variables like age, gender, education, and the number of children, background, symptoms, co-morbidity risk factors, affected valves, etiologies, electrocardiographic and echocardiographic findings, and suggested treatments. The etiologies of VHD were classified according to history, as well as clinical and echocardiographic findings. | This study showed that the main cause of VHD is rheumatic fever. Mitral regurgitation and multiple valvular lesions are the most frequent VHDs in Turkey. Percutaneous mitral balloon valvuloplasty and mechanical prosthetic valve replacement are the preferred treatment methods for VHD. |
| https://doi.org/10.1007/s00392-023-02168-6 | Age period cohort analysis of rheumatic heart disease in high-income countries | Hibino et al. 2023 | secondary data analysis (Age–Period–Cohort modelling) | General population in selected high-income countries, based on national health, mortality, or disease registries and global epidemiological datasets | The WHO mortality database was analyzed to determine trends in mortality from rheumatic heart disease in the UK, Germany, France, Italy, Japan, Australia, the USA, and Canada from 2000 to 2020. Age-cohort-period modeling was used to estimate cohort and period effects. Net drift (overall annual percentage change), local drift (annual percentage change in each age group), and heterogeneity were calculated. | Mortality trends from rheumatic heart disease were decreasing in the study high-income countries, except for Germany where higher mortality and two peaks in annual percentage change in younger and older age groups warrant further investigation. |
| https://doi.org/10.1186/s12969-019-0314-9 | Screening of asymptomatic rheumatic heart disease among refugee/migrant children and youths in Italy | Condemi et al. 2019 | prospective/observational | Migrant populations in Italy | From February 2016 to January 2018, Médecins Sans Frontières conducted a weekly mobile screening by echocardiography in reception centers and family houses for unaccompanied foreign minors in Rome, followed by fix echocardiographic retesting for those resulting positive at screening. ‘Definite’ and ‘borderline’ cases were defined according to the World Heart Federation criteria. | Screening for RHD among the unaccompanied migrant minors in Italy proved to be feasible. The burden of ‘definite RHD’ was similar to that identified in resource-poor settings, while the prevalence of ‘borderline’ cases was higher than reported in other studies. In view of these findings, the health system of high-income countries, hosting migrants and asylum seekers, are urged to adopt screening for RHD particular among the silent and marginalized population of refugee and migrant children. |
| https://doi.org/10.1017/S1047951119002075 | Echocardiographic screening for rheumaticheart disease in Turkish schoolchildren | Atalay et al. 2019 | prospective/multicenter | Schoolchildren in Turkey | This study aimed to investigate the prevalence of subclinical rheumatic heart disease in schoolchildren aged 5–18 by using portable echocardiography in Ankara, Turkey. The echocardiography screening was performed by a pediatric cardiologist for all the cases. Echocardiographic studies were assessed according to 2012 World Heart Federation criteria for RHD. | The frequency of rheumatic heart disease was found to be 15/1000, a finding similar to those of recent echocardiographic screening studies performed in middle and high-risk populations. It was concluded that to decrease the burden of RHD, echocardiographic screening studies are necessary, and long-term follow-up of children with echocardiographically diagnosed subclinical rheumatic heart disease is needed. |
| https://pubmed.ncbi.nlm.nih.gov/19301555 | The spectrum of rheumatic heart disease in the southeastern Anatolia endemic region: results from 1900 patients | Ozer at al. 2009 | retrospective | People presenting for echocardiography examination at a cardiology laboratory in the Southeastern Anatolia region in Tukey | In this retrospective study, transthoracic echocardiographic data acquired between June 2003 and January 2008 were reviewed. Information was gathered from the database of the authors’ echocardiography laboratory, which included age, gender, clinical diagnosis, and echocardiographic findings. In patients with more than one echocardiographic record, only the first echocardiographic data were included in the study. | A first admission with full echocardiographic data of RHD was found in 1,900 cases among 43,900 subjects screened (4.3%). Currently, RHD remains an alarming and unresolved health problem in the Southeastern Anatolia region. While almost 75% of affected subjects were female, males were more severely affected. In addition, subjects were relatively old, and most were affected by mixed valvular disease of an advanced stage. |
| https://doi.org/10.1007/s00404-009-1050-z | Pregnancy outcomes in women with heart disease | Madazli et al. 2010 | retrospective | Pregnant women with cardiac disease in Turkey | A retrospective analysis was carried out of 144 pregnancies in women with cardiac disease who delivered at Cerrahpaşa Medical Faculty in Istanbul between 1997 and 2006. Perinatal and maternal outcomes were interpreted according to the type of heart disease and status of the patient according to the New York Heart Association (NYHA) classification. | The rate of RHD was 87.5%. Rheumatic heart disease with pregnancy is still predominant in Turkey. Most of the patients were in a good functional group. Maternal morbidity strongly correlates with maternal cardiac classification. |
| https://doi.org/10.14744/AnatolJCardiol.2019.55267 | Screening and evaluation of newly diagnosed cardiovascular diseases in first-trimester asymptomatic pregnant women in a tertiary antenatal care center in Turkey | Bozkaya et al. 2020 | prospective | Pregnant women without cardiac disease in Turkey | A total of 900 women in the first trimester of pregnancy, who attended the antenatal outpatient clinic of a tertiary care center in Ankara, Turkey, for a routine pregnancy examination, were recruited into this prospective study. Patients with a history of chronic systemic diseases, cardiovascular disease, and/or a family history of an early onset cardiovascular disease, and multiple pregnancies were excluded. Patients who were included in the study underwent electrocardiography and transthoracic echocardiography by the same cardiologist. | A cardiovascular disease rate of 5.2% was observed among healthy women in the first trimester of pregnancy, of whom 55.3% had RHD. These results show that clinicians must keep in mind that during pregnancy, physiological changes in the cardiovascular system may aggravate an undiagnosed disease, and they should be alert even in case of mild cardiac symptoms that may interfere with pregnancy complaints. |
| https://doi.org/10.1161/CIRCULATIONAHA.117.032561 | Pregnancy outcomes in women with rheumatic mitral valve disease results from the registry of pregnancy and cardiac disease | van Hagen et al. 2018 | observational registry study | Pregnant women with cardiac disease from emerging countries | The Registry of Pregnancy and Cardiac Disease is an international prospective registry, and consecutive pregnant women with cardiac disease were included. Pregnancy outcomes in all women with rheumatic mitral valve disease and no pre-pregnancy valve replacement were described in the study (n = 390). A maternal cardiac event was defined as cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, and hospitalization for other cardiac reasons or cardiac intervention. Associations between patient characteristics and cardiac outcomes were checked in a 3-level model (patient–center–country). | RHD was diagnosed in 380 patients. Mortality was 1.9% during pregnancy. Around 50% of the patients with severe rheumatic MS and 23% of those with significant MR developed heart failure during pregnancy. Pre-pregnancy counseling and considering mitral valve interventions in selected patients are important to prevent these complications. |