Congenital Heart Disease in Saudi Arabia A Systematic Review Authors Amirah M Alenezi Nada M AlBwardi Anna Ali Mowafa Househ Ashraf ElMetwally Presenter Ashraf ID: 246631
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Slide1
The Epidemiology of Congenital Heart Disease in Saudi Arabia: A Systematic Review
Authors
Amirah M AleneziNada M AlBwardiAnna Ali Mowafa Househ Ashraf El-MetwallySlide2
Presenter: Ashraf El-Metwally
Assistant professor of Epidemiology, Collage of Public Health and Health Informatics, King Saud bin
Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Slide3
3
CHD
CHD :“A gross structural abnormality of the heart
or intra-thoracic great vessels that is actually or potentially of functional significance
(Mitchell SC et al, 1971)Range of defects varies from a single simple defect with no symptoms to multiple complex of defects with several symptoms. (
Bernier PL et al, 2010)
Minor heart defects may not affect the quality of life of the patient.
(
Koshnood
B et al, 2010 van der
Bom
T et al, 2012)Severe heart defects would require extensive medical support. (Koshnood B et al, 2010 van der Bom T et al, 2012)
BackgroundSlide4
4
Etiology
Etiology is not known, but CHD is linked with either genetic or environmental
predisposition. (Blue GM et al, 2012)
Down’s syndrome and consanguinity are more frequently associated with CHD. (Blue GM et al, 2012)
Evidence
for the contribution of specific environmental factors to CHD causation is limited.
(
Blue GM et al, 2012
)
Folic
acid supplementation in the preconception period, ensuring rubella vaccination has been completed before pregnancy, and maintaining good glycemic control in mothers with diabetes may reduce the risk of CHD in infants
. (Blue GM et al, 2012)BackgroundSlide5
5
Global Burden
Wide variation in the incidence of CHD varying from 4/1000 to 50/1000 live
births. (Hoffman JIE et al, 2004)
International studies have reported prevalence ranging from 10-119 per 10,000 persons. (Dolk et al, 2010 Koshnood et al, 2012 Marelli et al, 2007 van der Bom T et al, 2012)
Variation is primarily due to the use of different methods to diagnose
CHD.
(
Hoffman JIE et
al,
2004)
The
relative frequency of different major forms of CHD also differs greatly between studies. (Hoffman JIE et al, 2004)The total incidence of CHD is dependent on the relative frequency of VSDs, the most common type of CHD. (Hoffman JIE et al, 2004)
BackgroundSlide6
6
Aims
No recent systematic review has examined the growing scientific evidence with respect to the epidemiology of CHD in the KingdomTo provide a comprehensive summary of CHD
Incidence
To
better understand the disease's
magnitude
Aid
in future public health
initiatives in Saudi Arabia
Burden
Impact
Prevalence
AimsSlide7
7
Methods
An electronic search was conducted in January 2014PubMed and Google
ScholarSupplementary search for articles: Cross-referencing and
Reviewing locally published journalsSlide8
8
Methods
HeartCardiac
CongenitalDefectEpidemiology
PrevalenceIncidenceRiskImpactSaudi Arabia
W
ritten
in
English
P
ublished
up to 2013
Treatment or
Interventional
studies
Keywords
Inclusion Criteria
Exclusion CriteriaSlide9
9
Flow ChartSlide10
10
Results
Prevalence Studies
Greer
W et al in 2005: Southwestern region had the highest burden of CHD with
prevalence
of
7.48
cases/
1000 persons, Central region (2.7), Northern region (2.5)
Alqurashi
et al
in 2004-05: Prevalence of CHD in children and adolescents was 2.1 cases /1000 personsAlnajjar et al in 2009: Reported 2,047 new cases of CHD, 34% of all cardiac cases in Al MadinaAlmawazini
and
Al Ghamdi
in 2011:
26.8%
of all cardiac patients were
diagnosed with
CHD in Southern Western Saudi
Al-
Mesned
et al in 2012: Incidence
of severe CHD was 5.4 per 1,000 live birth/yearSlide11
11
Results
Prevalence Studies
Most common type of defect reported by studies was
VSDJaiyesimi et al in 1993: Among prospective
cohort of 320 patients 38.5%
had
VSD
Bhat et al
in
1997: Among 1209 children
referred to the cardiology clinic 29.7% had VSDAbbag F et al in 1998: Among 608 CHD cases 32.5% had VSD
Alabdulgader
et al in
2001
:
Among 740 CHD cases 39.5% had
VSD
ASD (8.9% to 18.1%) and PS (6% to 12.4%)Slide12
12
Results
Risk Factor Studies
Risk factors that were highlighted in different studies include:
Down SyndromeConsanguineous marriage Diabetic mothers
Social
ImpactSlide13
13
Results
Risk Factor Studies
Down Syndrome(DS)
Jaiyesimi et al in 1993: Among 320 cases of CHD, trisomy-21 was found in 10%.
Alabdulgader
et al in 2001: DS was
found in 6% of all
patients.
Al-
Jarallah
et al in 2009: Among 110 down syndrome 49% had CHD.Aama et al in 2012: 130 patients with DS, CHD in 86.8%Abbag
et al in 2006: CHDs
was
found
in 61.3%
with
DS.Slide14
14
Results
Risk Factor Studies
Consanguineous
Marriage Becker and AlHalees in 1999: First cousin marriages in 41.6% of children with CHD, compared to only 28.4% in general public.
Seliem
et al
in
2007
:
62 % of CHD children were product of first cousin marriages
El
Mouzan et al in 2008: 56% of children with CHD were product of consanguineous marriages and CHD to be the only statistically significant disease associated with first cousin consanguinitySlide15
15
Results
Risk Factor Studies
Maternal Diabetes
Abu-Sulaiman et al in 2004: CHD among children of 100 diabetic mothers was determined to be higher than in the general public
;
15/1,000
live
births
Social Impact
Almesne
et
al 2013: Families of children with complex CHD had significantly higher IFS score, 62 vs. 51 (P=0.005)Slide16
16
Discussion
Cross-sectional studies found the prevalence of CHD ranging between 2.1 to
10.7/ 1,000 persons
The most prevalent type : VSD ranging from 29.5% to 39.5% of all diagnosed CHDs, followed by
ASD
(8.9% to 18.1%) and
PS
(6% to 12.4
%)
Incidence of severe CHD : 5.4/1,000 live births per year
Occurrence
of CHD in Saudi Arabia: Significantly associated with Down ’s syndrome, consanguinity and maternal
diabetes
1
2
3
4Slide17
17
Limitations
Limiting our search for articles in English
Publication bias
Limitations
of the individual studies
Very
few follow-up studies
1
2
3
4Slide18
18
Comparison with Other
Studies
International studies have reported prevalence rates ranging from 1-11.9
per 1000 persons. (Dolk et al, 2010 Koshnood et al, 2012 Marelli et al, 2007
van der
Bom
T et al,
2012
).
In KSA ranges from 2.1- 10.7 per 1000 persons
Common
cardiac congenital lesion reported in KSA was VSD ranging from 29.5% to 39.5%which is consistent with other parts of the world.(Hoffman et al, 2004Koshnood et al, 2012 Rose et al, 1964)The 2nd most common type of CHD in KSA, ASD, was also 2nd most frequent in incidence studies in the US, Canada and Bohemia while other studies found it to be less common; the 4th most common form in Hungary at 10.4%and the 5th most common type in Sweden at 4.3%.(
Carlgren
1959
Mészáros
et al, 1975Mitchell et al 1971,
Samánek
et al, 1989)Slide19
19
Comparison with Other Studies
Presence
of CHD in children with Down's syndrome ranged from
40% to 55% in international studies same as reported in KSA. (de Rubens et al, 2003 Roizen et al, 2014Vida et al, 2005 Wells et al 1994)
In KSA first cousin marriage was significantly associated with VSD, ASD, AVSD, PS, and PA. Similarly,
septal
defects (VSD and ASD) were consistently found to be associated with consanguinity especially at first cousin level, in several international
studies.
(
Al Husain
et al, 1997)Slide20
20
General
understanding of the CHD epidemiology in Saudi ArabiaCHD have prevalence higher than that in Western countries and comparable to those reported in other developing countries
Consanguineous marriages, maternal age, Diabetes and Down syndrome
were among risk factors related to CHD
1
2
3
Identified risk factors are potentially modifiable, emphasizing the importance of public health
programs
Studies that explored the prognosis and burden of these diseases on the Saudi society and healthcare services are scarce and should be the focus for future
research
4
5
Conclusion and RecommendationsSlide21
21
Thank You For
Y
our Attention