ABC | Volume 113, Nº3, September 2019

Original Article Rheumatic Fever: A Disease without Color Estevão Tavares de Figueiredo, 1 Luciana Azevedo, 2 Marcelo Lacerda Rezende, 2 C ristina Garcia Lopes Alves 2 Faculdade de Medicina de Ribeirão Preto (FMRP) da Universidade de São Paulo (USP), 1 Ribeirão Preto, SP – Brazil Universidade Federal de Alfenas, 2 Alfenas, MG – Brazil Mailing Address: Estevão Tavares de Figueiredo • Departamento de Clínica Médica da FMRP - USP - Avenida Bandeirantes, 3900. postal Code 14049-900, Ribeirão Preto, SP – Brazil E-mail: etavaresdefigueiredo@gmail.com Manuscript received August 17, 2018, revised manuscript November 15, 2018, accepted December 19, 2018 DOI: 10.5935/abc.20190141 Abstract Background: Brazil has approximately 30.000 cases of Acute Rheumatic Fever (ARF) annually. A third of cardiovascular surgeries performed in the country are due to the sequelae of rheumatic heart disease (RHD), which is an important public health problem. Objectives: to analyze the historical series of mortality rates and disease costs, projecting future trends to offer new data that may justify the need to implement a public health program for RF. Methods: we performed a cross-sectional study with a time series analysis based on data from the Hospital Information System of Brazil from 1998 to 2016. Simple linear regression models and Holt’s Exponential Smoothing Method were used to model the behavior of the series and to do forecasts. The results of the tests with a value of p < 0.05 were considered statistically significant. Results: each year, the number of deaths due to RHD increased by an average of 16.94 units and the mortality rate from ARF increased by 215%. There was a 264% increase in hospitalization expenses for RHD and RHD mortality rates increased 42.5% (p-value < 0.05). The estimated mortality rates for ARF and RHD were, respectively, 2.68 and 8.53 for 2019. The estimated cost for RHD in 2019 was US$ 26.715.897,70. Conclusions: according to the Brazilian reality, the 1-year RHD expenses would be sufficient for secondary prophylaxis (considering a Benzatin Penicillin G dose every 3 weeks) in 22.574 people for 10 years. This study corroborates the need for public health policies aimed at RHD. (Arq Bras Cardiol. 2019; 113(3):345-354) Keywords: Rheumatic Fever; Rheumatic Heart Disease; Cardiovascular Surgical Procedures/mortality; Hospitalization/ economics; Antibiotic Prophylaxys/economics; Public Health Policy. Introduction According to the Brazilian Institute of Geography and Statistics (IBGE), Brazil has 10million cases of pharyngotonsillitis every year, leading to approximately 30.000 cases of Acute Rheumatic Fever (ARF). 1 Rheumatic Heart Disease (RHD) has a low incidence in developed countries, with 0.1 to 0.4 cases/1,000 school children in the US, while in Brazil these values are 7 cases/1.000 school children, showing that it is directly associated with environmental and socioeconomic factors. 2 Approximately 70% of the patients with acute RF develop carditis and a third of the cardiovascular surgeries performed in Brazil are due to of RHD sequelae. 3,4 RF was responsible for 5.1 million potential disability-adjusted life years (DALYs), resulting from 280.000 deaths in 2004, and it was the seventh and eighth causes of mortality and morbidity due to neglected diseases, respectively. 5 Rheumatic fever is a disease with a cross-linked autoimmune nature triggered by susceptible host response after pharyngotonsillitis by Group A β -hemolytic Streptococcus. 6–8 The implementation of treatment for pharyngotonsillitis by Group A β -hemolytic Streptococcus with Benzathine Penicillin G (BPG) within nine days of symptom onset can eradicate the infection and prevent a first outbreak of acute RF 3 or a new outbreak, 9 whichwas already advocated by theWHO in 1955. 10 Unfortunately, the expected infection eradication rates do not seem to have been reached in Brazil, as shown by our analyses of data from the Health Information System (SIH) from the Brazilian National Health System (SUS). 11 SUS guarantees universal and egalitarian access to health care and services to everyone in the national territory. Therefore, Brazil’s health policies include care by the public (SUS) and the private sectors (supplementary healthcare, or private health plans), plus care by the private sector within the public sector (complementary health) and by the public sector within the private sector (regulation, inspection, surveillance). Herein, we disclose the cost analysis of health care and services related to RF and RHD incurred by SUS, i.e. under public management, which is different from that of the private systems. Considering the presented data and the absence of a national RF and RHD prevention program, the objective of this 345