Survey of current knowledge – practices among Egyptian physicians

Secondary prevention for rheumatic heart disease

This questionnaire was designed to assess current knowledge and degree of implementation of clinical practice guidelines for secondary prevention of rheumatic heart disease among Egyptian physicians.
It aims to evaluate real life experience among Egyptian physician, so please answer the questions based on your actual knowledge and clinical practice.

Data will be collected anonymously while maintaining confidentiality and data protection.

Do you agree to participate?(Required)

Yes

Age(Required)

(years)

Gender(Required)

Male

Female

Governorate (Please specify)(Required)

Last medical grade completed(Required)

Bachelor grade

Master degree

Doctorate degree

Place of work: (You can choose more than one option)(Required)

University hospital

Insurance hospital

General Hospital

Private hospital

Private clinic

Number of years of practicing medicine(Required)

Specialty(Required)

Cardiologist

Internal medicine

Cardiothoracic surgery

General practitioner

Other

Cardiac specialty (If cardiologist, You can choose more than 1 option):(Required)

General cardiology

Imaging

Interventional cardiology

Electrophysiology

I am not a cardiologist.

How many rheumatic heart disease patients do you encounter in practice on monthly basis?(Required)

Do you know the criteria required to confirm the diagnosis of acute rheumatic fever?(Required)

Yes

Do you prescribe long-acting penicillin in patients with positive ASOT only but not fulfilling the modified Jones criteria?(Required)

Yes

Are there clinical scenarios in which we can diagnose rheumatic fever irrespective of fulfilling the modified Jones criteria?(Required)

Yes

I don’t know

Do you think echocardiography should be considered in all patients with suspected rheumatic fever even in the absence of cardiac symptoms?(Required)

Yes

I don’t know

Is subclinical carditis (echocardiographic findings without cardiac symptoms) considered a major criterion for diagnosis of rheumatic fever?(Required)

Yes

I don’t know

Do you recommend echocardiographic assessment for all cases with suspected rheumatic fever?(Required)

Yes

Are you familiar with the most recent guidelines recommendations (ACC/AHA 2020) for secondary prophylaxis of rheumatic fever in different clinical scenarios?(Required)

Yes

Based on the international clinical practice guidelines, were there any changes in the secondary prevention regimens for rheumatic fever in the past 5 years?(Required)

Yes

I don’t know

How long do you prescribe secondary antibiotic prophylaxis in young adults with history of rheumatic fever without residual cardiac disease (no valvular abnormality)(Required)

1-2 years

Till the age of 21 years

Till the age of 25 years

Till the age of 35 years

Till the age of 40 years

How long do you prescribe secondary antibiotic prophylaxis in young adults with established rheumatic heart disease?(Required)

1-5 years

6 – <10 years

10 years

Till the age of 21 years

Till the age of 35 years

Till the age of 40 years

Which regimen do you think is more effective in secondary prophylaxis in rheumatic heart disease patients?(Required)

Long acting benzathine penicillin

Oral penicillin

Both of them are equally effective

I don’t know

What are the intervals you prescribe commonly for initiation of benzathine penicillin therapy in adults with established rheumatic heart disease?(Required)

Every 14 days

Every 21 days

Every 28 days

Have you ever changed the frequency of long-acting penicillin administration according to the disease severity (Mild, moderate or severe)?(Required)

Yes

How frequent do you recommend performing an allergy test before benzathine penicillin injection?(Required)

First time only

At fixed intervals

Every time

Do you commonly encounter penicillin sensitive patients in your clinical practice?(Required)

Yes

Do you know the secondary prophylaxis regimen to be used in patients with established rheumatic heart disease and penicillin allergy?(Required)

Yes

How do you prefer to manage patients with rheumatic heart disease showing sensitivity to long acting penicillin injections?(Required)

Stop and don’t use another antibiotic

Stop long acting penicillin and prescribe oral penicillin

Stop long-acting penicillin and prescribe non-penicillin antibiotic

If you choose to Stop long-acting penicillin and prescribe non-penicillin antibiotic, Please specify the antibiotic you use and dosing(Required)

How do you follow up patients with established rheumatic heart disease to ensure the effectiveness of secondary prophylaxis?(Required)

ASOT and/or inflammatory markers (ESR or CRP)

By echocardiography

Both

I don’t recommend follow up in these patients

If you perform regular echocardiographic follow up in young adults with rheumatic heart disease, what are the intervals?(Required)

Every 6 months

Every one year

Depending on the severity of the disease

I don’t use echo for follow up

Is there clinical or echocardiographic criteria that need to be fulfilled before stopping secondary prophylaxis?(Required)

Yes

I don’t know

Have you ever prescribed lifelong prophylaxis in patients with rheumatic heart disease?(Required)

Yes

Do you prescribe long-acting penicillin injections or oral prophylaxis for rheumatic fever for all patients younger than 40 years of age after surgical valve replacement?(Required)

Yes

If no, what is your reason?(Required)

Not indicated after valve replacement

Not indicated in all patients after valve replacement but in specific cases

Optional due to low risk of recurrence after valve replacement

Indicated in all patients but fear from potential injections complications

Sometimes I forget to prescribe it in this clinical scenario

Other

Have you ever encountered complications from long acting penicillin injections in patients maintained on oral anticoagulation?(Required)

Yes

Other

If yes, how frequent did the complications occur?(Required)

<1%

1-5%

5-10%

>10%

Specify the type of complications(Required)

From your clinical experience, what is the percentage of patients younger than 40 years post surgical valve intervention receiving secondary prevention for rheumatic fever?(Required)

<50%

>50%

I don’t know

Have you ever encountered patients with new native rheumatic valve disease &/or new onset unexplained ventricular dysfunction years after surgical valve replacement of another rheumatically affected valve?(Required)

Yes

If yes, how frequent did you encounter this scenario?(Required)

In patients with new native rheumatic valve disease or new onset unexplained ventricular dysfunction years after surgical valve replacement of another rheumatically affected valve, how many of them were maintained on proper secondary prophylaxis for rheumatic fever? Please put an average percentage based on your practical experience, if you don’t know please mention that(Required)