Acute Rheumatic Fever prophylaxis in high-income countries: clinical observations from an Italian multicentre retrospective study

Key words: Acute rheumatic fever, Compliance, Carditis, Prophylaxis, Rheumatic heart disease

Objective - The aim of the study is to evaluate the compliance rate to secondary prophylaxis and the presence of Rheumatic Heart Disease (RHD) in a cohort of Italian patients with Acute Rheumatic Fever (ARF).
Methods - This is a multicentre retrospective study. Patients were divided into two groups according to the presence or absence at last follow-up of RHD. Clinical features, ARF recurrences and the rate of compliance to secondary prophylaxis were evaluated.
Results - wo hundred and ninety patients were enrolled (137 females, 153 males). Carditis at onset was present in 244 patients (84.7%). At the end of follow-up, 173 patients showed RHD. Adherence to secondary prophylaxis was low in 26% of patients. The presence of RHD at follow-up was associated with the presence of carditis and its severity at onset (p = 0.001), but it was not related to secondary prophylaxis adherence (p = NS). No association between prophylaxis adherence and ARF recurrence was found p = NS) nor between ARF recurrence and RHD at the end of follow-up (p = NS).
Conclusions - Poor adherence to secondary prophylaxis does not seem to be associated with increased risk of RHD in developed countries. Further studies are needed to confirm the reported data in a larger population.