1. Drug-Induced- or Rheumatic- Valvular Heart Disease in Patients Exposed to Benfluorex?
- Author
-
Yves Etienne, Zarrin Alavi, Florent Le Ven, Romain Didier, Yannick Jobic, Raphaël Porcher, Département Cardiologie, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'épidémiologie Clinique [Hôtel-Dieu], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Hôtel Dieu
- Subjects
Male ,Pediatrics ,Etiology ,Heart Valve Diseases ,lcsh:Medicine ,030204 cardiovascular system & hematology ,Pathology and Laboratory Medicine ,Diagnostic Radiology ,Geographical Locations ,chemistry.chemical_compound ,0302 clinical medicine ,Risk Factors ,Epidemiology ,Ultrasound Imaging ,Medicine and Health Sciences ,030212 general & internal medicine ,lcsh:Science ,ComputingMilieux_MISCELLANEOUS ,Benfluorex ,Multidisciplinary ,Radiology and Imaging ,valvular heart disease ,Middle Aged ,Markov Chains ,Drug Marketing ,3. Good health ,Europe ,Echocardiography ,Physical Sciences ,Female ,France ,Rheumatic Fever ,Research Article ,medicine.medical_specialty ,Markov Models ,Drug Research and Development ,Death Rates ,Imaging Techniques ,Inflammatory Diseases ,Cardiology ,Research and Analysis Methods ,03 medical and health sciences ,Population Metrics ,Rheumatology ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Diagnostic Medicine ,Appetite Depressants ,Fenfluramine ,Valvular Diseases ,medicine ,Humans ,In patient ,Sensitivity analyses ,Aged ,Demography ,Pharmacology ,Population Biology ,business.industry ,lcsh:R ,Rheumatic Heart Disease ,Biology and Life Sciences ,Acute rheumatic fever ,medicine.disease ,Probability Theory ,Patient population ,chemistry ,People and Places ,lcsh:Q ,business ,Mathematics - Abstract
There is a risk of misdiagnosis between benfluorex-induced VHD and acute rheumatic fever (ARF)-related VHD due to common characteristics of both etiologies. We aimed at estimating the probability for a patient exposed to benfluorex presenting with VHD to have, at the same time, a history of ARF-related VHD. Such epidemiological approach could help at reducing the risk of misdiagnosis. We used INSEE data and related literature as well as various modeling hypotheses to drive and test a formula for calculating the probability of a patient presenting with VHD and a history of benfluorex intake to have a prior history of ARF-related VHD. Different scenarios were estimated by a Markov model on the life course of people born in France between 1940 and 1960. Sensitivity analyses were performed under these scenarios. According to the different scenarios and gender, the probability that a patient born between 1940 and 1960 presenting with VHD and a history of benfluorex intake would have had a prior history of ARF-related VHD varied from 0.2% to 2.7%. The probabilities by the year of birth were as follows: 0.8%-2.7% for a patient born in 1940, < 0.5% in all scenarios for patients born after 1955, and < 0.2% in all scenarios for patients, born in 1960. Our results indicate that the burden of ARF-related VHD is low in the patient population exposed to benfluorex. The probability of ARF related VHD should not be over-estimated in the diagnostic procedure of VHD.
- Published
- 2016