{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T15:11:39Z","timestamp":1788966699705,"version":"build-2803163510"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Acute rheumatic fever (ARF) and its sequela, rheumatic heart disease (RHD), continue to be major contributors to morbidity and mortality among acquired pediatric cardiac diseases in underprivileged populations. The resulting health expenditures lead to catastrophic financial strain on affected families.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>This study analyzed 48 children admitted with ARF or RHD. Data collection focused on total healthcare costs, out-of-pocket expenditures (OOPE) by families, and associated financial impact.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 70 hospital admissions were evaluated. The mean age of patients was 11.3 \u00b1 3.1 years. Forty-six (66%) were admitted for decompensated heart failure (HF) due to first episode of ARF in 19 (27%) and recurrence in 17 (24%). Thirty-one (64%) underwent surgery, with two postoperative deaths (6%). Eighty eight (88%) families belonged to upper lower-middle socioeconomic class. The mean hospital stay was 11.5 \u00b1 5 days. Children lost an average of 230 \u00b1 128 school days.Families had an average size of 5.2 \u00b1 1.2 members, with 2.89 \u00b1 0.96 children. In 24 families (50%), both parents were earning. The average daily household income was \u20b9625 \u00b1 210. Of the families, 8 (16%) earned &lt;\u20b9500 per day. The funding organization (government\/trust) covered an average of \u20b9285,000 \u00b1 66,300 for surgery and \u20b930,000 \u00b1 17,650 for HF. Families incurred OOPE of \u20b946,000\u00b1 \u20b934,000 for surgeries and \u20b918,000\u00b1 \u20b910,000 for HF admissions. This was financed through loans or support networks. Families lost an average of 150 \u00b1 78 workdays. The estimated financial loss per family was \u20b9160,000 \u00b1 90,000; 10 times the monthly household income. On average, each follow-up hospital visit cost families \u20b95000 \u00b1 1600, about nine times their average daily income.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>ARF and RHD impose a significant financial burden on affected households over and above the funding support for hospitalization and surgery. The substantial indirect costs due to loss of work and travel expenses need to be included to know the complete economic impact of ARF and RHD on families.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/apc.apc_84_26","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:17:55Z","timestamp":1788949075000},"page":"503-512","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Rheumatic Heart disease in the Young: Treatment needs, Hospitalization burden, and Measuring economic impact: The RHYTHM Study"],"prefix":"10.4103","volume":"19","author":[{"given":"Sowmya","family":"Kasturi","sequence":"first","affiliation":[{"name":"Department of Pediatric Cardiology, Sri Padmavathi Children\u2019s Heart Centre, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srinath Reddy","family":"Narahari","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Sri Padmavathi Children\u2019s Heart Centre, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swetha","family":"Ponnapalli","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Paediatric Cardiac Intensive Care, Sri Padmavathi Children\u2019s Heart Centre, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Sindhoori","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Paediatric Cardiac Intensive Care, Sri Padmavathi Children\u2019s Heart Centre, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raman Krishna","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Paediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"R1-20260909","doi-asserted-by":"crossref","first-page":"1806","DOI":"10.1161\/CIR.0000000000000205","article-title":"Revision of the Jones criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography","volume":"131","author":"Gewitz","year":"2015","journal-title":"Circulation"},{"key":"R2-20260909","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1038\/nrcardio.2012.7","article-title":"World Heart federation criteria for echocardiographic diagnosis of rheumatic heart disease-an evidence-based guideline","volume":"9","author":"Rem\u00e9nyi","year":"2012","journal-title":"Nat Rev 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