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Article ; Online: Update on Prevention and Management of Rheumatic Heart Disease.

Sable, Craig

2020 Volume 67, Issue 5, Page(s) 843–853

Abstract: Rheumatic heart disease (RHD) remains the most common cause of cardiovascular morbidity and mortality globally in children and young adults. This article focuses on prevention and management of RHD. Pregnancy can unmask previously undiagnosed RHD and ... ...

Abstract	Rheumatic heart disease (RHD) remains the most common cause of cardiovascular morbidity and mortality globally in children and young adults. This article focuses on prevention and management of RHD. Pregnancy can unmask previously undiagnosed RHD and poses high risk for mother and fetus. Management of anticoagulation is important. Definitive catheter and surgical intervention are the only treatments that can improve outcomes of patients with moderate or severe RHD. Access to intervention remains very limited in RHD endemic regions. There are ongoing global efforts to increase awareness, public policy adoption, and greater access to treatment.
MeSH term(s)	Child ; Disease Management ; Disease Progression ; Echocardiography ; Global Health ; Humans ; Mass Screening/methods ; Morbidity ; Rheumatic Heart Disease/diagnosis ; Rheumatic Heart Disease/epidemiology
Keywords	covid19
Language	English
Publishing date	2020-08-11
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	215711-1
ISSN	1557-8240 ; 0031-3955
ISSN (online)	1557-8240
ISSN	0031-3955
DOI	10.1016/j.pcl.2020.06.003
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Article: Update on Prevention and Management of Rheumatic Heart Disease

Sable, Craig

Pediatr Clin North Am

Abstract	Rheumatic heart disease (RHD) remains the most common cause of cardiovascular morbidity and mortality globally in children and young adults. This article focuses on prevention and management of RHD. Pregnancy can unmask previously undiagnosed RHD and poses high risk for mother and fetus. Management of anticoagulation is important. Definitive catheter and surgical intervention are the only treatments that can improve outcomes of patients with moderate or severe RHD. Access to intervention remains very limited in RHD endemic regions. There are ongoing global efforts to increase awareness, public policy adoption, and greater access to treatment.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #32888685
Database	COVID19

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Article ; Online: Cardiac involvement in COVID-19: cause or consequence of severe manifestations?

Nascimento, Bruno Ramos / Sable, Craig

Heart (British Cardiac Society)

2021 Volume 108, Issue 1, Page(s) 7–8

MeSH term(s)	COVID-19 ; Heart ; Humans ; Myocarditis ; SARS-CoV-2
Language	English
Publishing date	2021-10-16
Publishing country	England
Document type	Editorial ; Comment
ZDB-ID	1303417-0
ISSN	1468-201X ; 1355-6037
ISSN (online)	1468-201X
ISSN	1355-6037
DOI	10.1136/heartjnl-2021-320246
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Article ; Online: Congenital heart disease in low-and-middle-income countries: Focus on sub-Saharan Africa.

Zimmerman, Meghan / Sable, Craig

American journal of medical genetics. Part C, Seminars in medical genetics

2020 Volume 184, Issue 1, Page(s) 36–46

Abstract: The etiology of congenital heart disease (CHD) is multifactorial. The birth prevalence of CHD is shaped by a wide variety of maternal, fetal, and neonatal risk factors, along with the rates of prenatal diagnosis and terminations of pregnancy, all of ... ...

Abstract	The etiology of congenital heart disease (CHD) is multifactorial. The birth prevalence of CHD is shaped by a wide variety of maternal, fetal, and neonatal risk factors, along with the rates of prenatal diagnosis and terminations of pregnancy, all of which have geographic variability Epidemiology data availability from low-and-middle-income countries (LMIC) on CHD prevalence, morbidity, and mortality are far more limited than from high income countries. Data on specific genetic, environmental, and prenatal risk associated with CHD are almost nonexistent. In this article, we will focus on defining what data are available, genetic risk factors, birth and overall prevalence, morbidity, and the impact of limited access to interventions, both surgery and cardiac catheterizations. We will highlight CHD in sub-Saharan Africa to detail epidemiology studies in the poorest regions of the world. Existing literature as well as estimates from the Global Burden of Disease Study (http://ghdx.healthdata.org) form the basis for this review. The intersection of poverty, high fertility rates, and limited access to care results in a unique profile of CHD in LMIC. CHD is not a preventable disease (by most standards), so early detection and access are our key interventions to improve the dire outcomes for children in low-resources settings of the world.
MeSH term(s)	Africa South of the Sahara/epidemiology ; Child ; Delivery of Health Care ; Developing Countries/economics ; Female ; Heart Defects, Congenital/economics ; Heart Defects, Congenital/epidemiology ; Heart Defects, Congenital/pathology ; Heart Defects, Congenital/therapy ; Humans ; Poverty ; Pregnancy ; Risk Factors
Language	English
Publishing date	2020-02-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2108622-9
ISSN	1552-4876 ; 0148-7299 ; 1552-4868
ISSN (online)	1552-4876
ISSN	0148-7299 ; 1552-4868
DOI	10.1002/ajmg.c.31769
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Article ; Online: Using Artificial Intelligence for Rheumatic Heart Disease Detection by Echocardiography: Focus on Mitral Regurgitation.

Brown, Kelsey / Roshanitabrizi, Pooneh / Rwebembera, Joselyn / Okello, Emmy / Beaton, Andrea / Linguraru, Marius George / Sable, Craig A

Journal of the American Heart Association

2024 Volume 13, Issue 2, Page(s) e031257

Abstract: Background: Identification of children with latent rheumatic heart disease (RHD) by echocardiography, before onset of symptoms, provides an opportunity to initiate secondary prophylaxis and prevent disease progression. There have been limited artificial ...

Abstract	Background: Identification of children with latent rheumatic heart disease (RHD) by echocardiography, before onset of symptoms, provides an opportunity to initiate secondary prophylaxis and prevent disease progression. There have been limited artificial intelligence studies published assessing the potential of machine learning to detect and analyze mitral regurgitation or to detect the presence of RHD on standard portable echocardiograms. Methods and results: We used 511 echocardiograms in children, focusing on color Doppler images of the mitral valve. Echocardiograms were independently reviewed by an expert adjudication panel. Among 511 cases, 229 were normal, and 282 had RHD. Our automated method included harmonization of echocardiograms to localize the left atrium during systole using convolutional neural networks and RHD detection using mitral regurgitation jet analysis and deep learning models with an attention mechanism. We identified the correct view with an average accuracy of 0.99 and the correct systolic frame with an average accuracy of 0.94 (apical) and 0.93 (parasternal long axis). It localized the left atrium with an average Dice coefficient of 0.88 (apical) and 0.9 (parasternal long axis). Maximum mitral regurgitation jet measurements were similar to expert manual measurements ( Conclusions: Artificial intelligence has the potential to detect RHD as accurately as expert cardiologists and to improve with more data. These innovative approaches hold promise to scale echocardiography screening for RHD.
MeSH term(s)	Child ; Humans ; Mitral Valve Insufficiency/diagnostic imaging ; Rheumatic Heart Disease/diagnostic imaging ; Artificial Intelligence ; Sensitivity and Specificity ; Echocardiography/methods
Language	English
Publishing date	2024-01-16
Publishing country	England
Document type	Journal Article
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.123.031257
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Article ; Online: Fever, Neck Stiffness, and Leg Pain in a 6-year-old Boy.

Rueda, Maria S / Kulesa, John T / Sable, Craig / Manicone, Paul

Pediatrics in review

2021 Volume 42, Issue 8, Page(s) 463–467

MeSH term(s)	Child ; Fever/etiology ; Humans ; Leg ; Male ; Neck Pain/diagnosis ; Neck Pain/etiology ; Pain/etiology
Language	English
Publishing date	2021-10-28
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	774515-1
ISSN	1526-3347 ; 0191-9601
ISSN (online)	1526-3347
ISSN	0191-9601
DOI	10.1542/pir.2020-002600
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Article: Impact of Technologic Innovation and COVID-19 Pandemic on Pediatric Cardiology Telehealth.

Shah, Sanket S / Buddhavarapu, Amulya / Husain, Majid / Sable, Craig / Satou, Gary

Current treatment options in pediatrics

2022 Volume 8, Issue 4, Page(s) 309–324

Abstract: Purpose of review: Established telehealth practices in pediatrics and pediatric cardiology are evolving rapidly. This review examines several concepts in contemporary telemedicine in our field: recent changes in direct-to-consumer (DTC) pediatric ... ...

Abstract	Purpose of review: Established telehealth practices in pediatrics and pediatric cardiology are evolving rapidly. This review examines several concepts in contemporary telemedicine in our field: recent changes in direct-to-consumer (DTC) pediatric telehealth (TH) and practice based on lessons learned from the pandemic, scientific data from newer technological innovations in pediatric cardiology, and how TH is shaping global pediatric cardiology practice. Recent findings: In 2020, the global pandemic of COVID-19 led to significant changes in healthcare delivery. The lockdown and social distancing guidelines accelerated smart adaptations and pivots to ensure continued pediatric care albeit in a virtual manner. Remote cardiac monitoring technology is continuing to advance at a rapid pace secondary to advances in the areas of Internet access, portable hand-held devices, and artificial intelligence. Summary: TH should be approached programmatically by pediatric cardiac healthcare providers with careful selection of patients, technology platforms, infrastructure setup, documentation, and compliance. Payment parity with in-person visits should be advocated and legislated. Newer remote cardiac monitoring technology should be expanded for objective assessment and optimal outcomes. TH continues to be working beyond geographical boundaries in pediatric cardiology and should continue to expand and develop.
Language	English
Publishing date	2022-09-22
Publishing country	Switzerland
Document type	Journal Article ; Review
ISSN	2198-6088
ISSN	2198-6088
DOI	10.1007/s40746-022-00258-7
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Article ; Online: Direct-to-patient telemedicine: Expanding access to regional pediatric specialty care.

Atabaki, Shireen M / Shur, Natasha E / Munoz, Ricardo A / Bhuvanendran, Shivaprasad / Sable, Craig / Rojas, Christina R / Lopez-Magallon, Alejandro J / Clarke, Jonas C / Sabouriane, Cyrus E / Krishnan, Anita / Wessel, David L

Journal of investigative medicine : the official publication of the American Federation for Clinical Research

2024 Volume 72, Issue 2, Page(s) 248–255

Abstract: Telemedicine is seen as a useful tool in reducing gaps in health care but this technology-enabled care can also exacerbate health inequity if not implemented with a focus on inclusivity. Though many studies have reported improvements as well as ... ...

Abstract	Telemedicine is seen as a useful tool in reducing gaps in health care but this technology-enabled care can also exacerbate health inequity if not implemented with a focus on inclusivity. Though many studies have reported improvements as well as exacerbation of disparities in access to care in their telehealth programs, there does not exist a common evaluation tool to assess these programs. To mitigate the impact of COVID-19 on health care workers and protect medically vulnerable children, in March 2020 we expanded our pre-established specialty and subspecialty direct-to-patient pediatric telemedicine program in a high volume urban pediatric health system. Our program aimed to prevent disparities in pediatric health care. In this study, using a "Pillars of Access" approach as a model to evaluate impact and access to care of our direct-to-patient telemedicine program, we analyzed the patients that were seen pre-COVID versus post-COVID. Our study demonstrated an increase in telemedicine visits for patients from diverse socioeconomic and racial backgrounds, and geographically underserved communities. We also observed an increase in telemedicine visits for mental health complaints and for certain categories of high-risk patients. This study was not designed to identify language and cultural barriers to telemedicine. Future identification of these specific barriers is needed. The tool to evaluate telehealth impact/access to care through a "Pillars of Access" approach presented here could serve as a model for implementation of telehealth programs. Our study highlights telemedicine programs as a mechanism to address healthcare inequity and overcome barriers to care.
MeSH term(s)	Child ; Humans ; Telemedicine ; Delivery of Health Care ; COVID-19/epidemiology ; Health Inequities
Language	English
Publishing date	2024-01-10
Publishing country	England
Document type	Journal Article
ZDB-ID	1217870-6
ISSN	1708-8267 ; 0009-9279 ; 1081-5589
ISSN (online)	1708-8267
ISSN	0009-9279 ; 1081-5589
DOI	10.1177/10815589231222197
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Article ; Online: Outcomes of rheumatic fever in Uganda: a prospective cohort study.

Wirth, Scott H / Pulle, Jafesi / Seo, JangDong / Ollberding, Nicholas J / Nakagaayi, Doreen / Sable, Craig / Bowen, Asha C / Parks, Tom / Carapetis, Jonathan / Okello, Emmy / Beaton, Andrea / Ndagire, Emma

The Lancet. Global health

2024 Volume 12, Issue 3, Page(s) e500–e508

Abstract: Background: Rheumatic heart disease is the largest contributor to cardiac-related mortality in children worldwide. Outcomes in endemic settings after its antecedent illness, acute rheumatic fever, are not well understood. We aimed to describe 3-5 year ... ...

Abstract	Background: Rheumatic heart disease is the largest contributor to cardiac-related mortality in children worldwide. Outcomes in endemic settings after its antecedent illness, acute rheumatic fever, are not well understood. We aimed to describe 3-5 year mortality, acute rheumatic fever recurrence, changes in carditis, and correlates of mortality after acute rheumatic fever. Methods: We conducted a prospective cohort study of Ugandan patients aged 4-23 years who were diagnosed with definite acute rheumatic fever using the modified 2015 Jones criteria from July 1, 2017, to March 31, 2020, enrolled at three rheumatic heart disease registry sites in Uganda (in Mbarara, Mulago, or Lira), and followed up for at least 1 year after diagnosis. Patients with congenital heart disease were excluded. Patients underwent annual review, most recently in August, 2022. We calculated rates of mortality and acute rheumatic fever recurrence, tabulated changes in carditis, performed Kaplan-Meier survival analyses, and used Cox regression models to identify correlates of mortality. Findings: Data were collected between Sept 1 and Sept 30, 2022. Of 182 patients diagnosed with definite acute rheumatic fever, 156 patients were included in the analysis. Of these 156 patients (77 [49%] male and 79 (51%) female; data on ethnicity not collected), 25 (16%) died, 21 (13%) had a cardiac-related death, and 17 (11%) had recurrent acute rheumatic fever over a median of 4·3 (IQR 3·0-4·8) years. 16 (24%) of the 25 deaths occurred within 1 year. Among 131 (84%) of 156 survivors, one had carditis progression by echo. Moderate-to-severe carditis (hazard ratio 12·7 [95% CI 3·9-40·9]) and prolonged PR interval (hazard ratio 4·4 [95% CI 1·7-11·2]) at acute rheumatic fever diagnosis were associated with increased cardiac-related mortality. Interpretation: These are the first contemporary data from sub-Saharan Africa on medium-term acute rheumatic fever outcomes. Mortality rates exceeded those reported elsewhere. Most decedents already had chronic carditis at initial acute rheumatic fever diagnosis, suggesting previous undiagnosed episodes that had already compounded into rheumatic heart disease. Our data highlight the large burden of undetected acute rheumatic fever in these settings and the need for improved awareness of and diagnostics for acute rheumatic fever to allow earlier detection. Funding: Strauss Award at Cincinnati Children's Hospital, American Heart Association, and Wellcome Trust.
MeSH term(s)	Child ; Humans ; Male ; Female ; Rheumatic Fever/epidemiology ; Rheumatic Heart Disease/epidemiology ; Rheumatic Heart Disease/complications ; Uganda/epidemiology ; Myocarditis/complications ; Myocarditis/epidemiology ; Prospective Studies
Language	English
Publishing date	2024-02-16
Publishing country	England
Document type	Journal Article
ZDB-ID	2723488-5
ISSN	2214-109X ; 2214-109X
ISSN (online)	2214-109X
ISSN	2214-109X
DOI	10.1016/S2214-109X(23)00567-3
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Article ; Online: Specificity of the Modified Jones Criteria.

Pulle, Jafesi / Ndagire, Emma / Atala, Jennifer / Fall, Ndate / Okello, Emmy / Oyella, Linda Mary / Rwebembera, Joselyn / Sable, Craig / Parks, Tom / Sarnacki, Rachel / Nakitto, Miriam / de Loizaga, Sarah R / Wirth, Scott / Carapetis, Jonathan / Beaton, Andrea

Pediatrics

2024 Volume 153, Issue 3

Language	English
Publishing date	2024-01-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	207677-9
ISSN	1098-4275 ; 0031-4005
ISSN (online)	1098-4275
ISSN	0031-4005
DOI	10.1542/peds.2023-062624
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