Epidemic Intelligence Service Center for Surveillance, Epidemiology, and Laboratory Services Centers for Disease Control and Prevention Atlanta GA.
Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Chamblee GA.
J Am Heart Assoc. 2021 Oct 19;10(20):e020424. doi: 10.1161/JAHA.120.020424. Epub 2021 Oct 6.
Background Rheumatic heart disease (RHD) is a severe, chronic complication of acute rheumatic fever, triggered by group A streptococcal pharyngitis. Centralized patient registries are recommended for RHD prevention and control, but none exists in American Samoa. Using existing RHD tracking systems, we estimated RHD period prevalence and the proportion of people with RHD documented in the electronic health record. Methods and Results RHD cases were identified from a centralized electronic health record system, which retrieved clinical encounters with RHD () codes, clinical problem lists referencing RHD, and antibiotic prophylaxis administration records; 3 RHD patient tracking spreadsheets; and an all-cause mortality database. RHD cases had ≥1 clinical encounter with RHD codes, a diagnostic echocardiogram, or RHD as a cause of death, or were included in RHD patient tracking spreadsheets. Period prevalence per 1000 population among children aged <18 years and adults aged ≥18 years from 2016 to 2018 and the proportion of people with RHD with ≥1 clinical encounter with an RHD code were estimated. From 2016 to 2018, RHD was documented in 327 people (57.2%: children aged <18 years). Overall RHD period prevalence was 6.3 cases per 1000 and varied by age (10.0 pediatric cases and 4.3 adult cases per 1000). Only 67% of people with RHD had ≥1 clinical encounter with an RHD code. Conclusions RHD remains a serious public health problem in American Samoa, and the existing electronic health record does not include all cases. A centralized patient registry could improve tracking people with RHD to ensure they receive necessary care.
风湿性心脏病（RHD）是由 A 组链球菌性咽炎引发的一种严重的、慢性的风湿热并发症。建议使用集中的患者登记系统来预防和控制 RHD，但美属萨摩亚没有这样的系统。我们利用现有的 RHD 跟踪系统，估算了 RHD 时期患病率以及有记录的 RHD 患者比例。
我们从集中的电子健康记录系统中确定了 RHD 病例，该系统检索了与 RHD （ ）代码、提及 RHD 的临床问题列表以及抗生素预防用药记录相关的临床就诊记录；3 份 RHD 患者跟踪电子表格；以及全因死亡率数据库。RHD 病例有≥1 次与 RHD 代码、诊断性超声心动图或 RHD 作为死亡原因相关的临床就诊记录，或包含在 RHD 患者跟踪电子表格中。我们估计了 2016 年至 2018 年期间年龄<18 岁的儿童和年龄≥18 岁的成年人每 1000 人中有多少人患有 RHD 以及有≥1 次 RHD 代码记录的 RHD 患者比例。2016 年至 2018 年期间，有 327 人（57.2%：年龄<18 岁的儿童）记录有 RHD。总体 RHD 时期患病率为每 1000 人 6.3 例，且患病率随年龄而变化（每 1000 人中有 10.0 例儿科病例和 4.3 例成人病例）。仅有 67%的 RHD 患者有≥1 次 RHD 代码记录的临床就诊记录。
RHD 仍然是美属萨摩亚的一个严重的公共卫生问题，而现有的电子健康记录并未包含所有病例。集中的患者登记系统可以改善对 RHD 患者的跟踪，以确保他们获得必要的治疗。
