HIGH PREVALENCE OF RHEUMATIC HEART DISEASE IN 2603 SCHOOL CHILDREN IN NORTH-WEST INDIA WITH 6 MONTHS AND 2 YEARS FOLLOW-UP: AN ECHOCARDIOGRAPHIC SURVEY

Abstract Background The Rheumatic Heart disease in Timor Leste school students (RHD-TL) study identified Timor Leste as having some of the highest rates of definite rheumatic heart disease (RHD) in the world. The RHD-TL follow-up study aimed to assess the delivery and outcomes of the secondary prophylaxis program in known patients with echocardiographic screen detected definite and borderline RHD. Methods School-students in Timor Leste where reassessed over a 3-year period since the initial study in 2016. Prospective assessments included adherence to secondary prophylaxis, complications of prophylaxis, follow-up clinical assessment and serial echocardiography. Of the 48 patients, 25 Definite and 23 Borderline, 38 (79%) of all patients, and 92% of definite RHD cases have had one or more follow-up assessments including full datasets for adherence, recurrence rates and progression of disease. Follow-up is provided by the volunteer paediatric cardiology team and rheumatic heart disease team of two NGOs in collaboration with local clinics. Results The median duration of follow-up of the 38 patients was of 1.6 years. The median age was 13 years (range 8-22) and 75% were female. Adherence rates in patients with definite RHD was on average greater than 95% during the follow-up period. Of the 23 patients with mild or moderate RHD one case with documented acute rheumatic fever (ARF) recurrence progressed whilst 8 cases improved on benzathine-penicillin G (BPG) therapy. There was no progression of the 6 borderline cases who were not prescribed BPG. Out of the 9 borderline cases in whom BPG was prescribed, one, with 67% adherence, had a documented episode of ARF leading to echocardiographic progression and moderate definite RHD. Conclusion This was the first follow-up study to look at disease natural history, both in treated and untreated groups, in Timor-Leste and brought practical insights into the efficacy of the Timor Leste RHD monitoring and prophylaxis programs. Its ongoing project will enable advocacy and quality assessment for the program as it expands. Abstract 225 Figure 1.

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Community study to uncover the full spectrum of rheumatic heart disease in Uganda

Heart ◽

10.1136/heartjnl-2018-313171 ◽

2018 ◽

Vol 105 (1) ◽

pp. 60-66 ◽

Cited By ~ 4

Author(s):

Amy Scheel ◽

Isaac Ssinabulya ◽

Twalib Aliku ◽

Tyler Bradley-Hewitt ◽

Alexa Clauss ◽

...

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

Cluster Sampling ◽

Community Members ◽

Full Spectrum ◽

Critical Gap ◽

High Prevalence ◽

Gulu District ◽

Echocardiographic Evidence ◽

Rheumatic Heart

ObjectiveEstimates of the prevalence of rheumatic heart disease (RHD) in many endemic countries are limited to samples of children attending schools, which generate an incomplete picture of disease burden in communities. The present study conducted household-based RHD screening in a representative community in Gulu district, Uganda.MethodsMembers of households identified through a two-stage cluster-sampling approach between the ages of 5 years and 50 years were invited to undergo limited cardiac testing with a handheld echocardiogram to assess for the presence of RHD. Suspicious cases underwent confirmatory echocardiogram with a fully functional machine.ResultsOf the 2453 community members screened, 2.45% (95% CI 1.87% to 3.14%) showed echocardiographic evidence of RHD with 1.26% (95% CI 0.860% to 1.79%) having definite RHD. The overall prevalence of RHD among participants <20 years was 2.52% (95% CI 1.78% to 3.45%), with a borderline prevalence of 1.97% (95% CI 1.33% to 2.82%) and a definite prevalence of 0.544% (95% CI 0.235% to 1.07%). Prevalence rates among youth increased with age and peaked in the age group of 16–20 years. The overall adult prevalence (>20 years) of RHD was 2.34% (95% CI 1.49% to 3.49%). The majority of definite cases were mild (81%) and marked by mitral regurgitation and associated morphological valve changes (71%).ConclusionOur data reveal a high prevalence of undiagnosed RHD within an endemic community and fill a critical gap in RHD epidemiology in African adults.

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Prevalence of rheumatic heart disease among school children in East Africa: a systematic review and meta-analysis

Pan African Medical Journal ◽

10.11604/pamj.2021.38.242.26058 ◽

2021 ◽

Vol 38 ◽

Author(s):

Melaku Bimerew ◽

Biruk Beletew ◽

Addisu Getie ◽

Adam Wondmieneh ◽

Getnet Gedefaw ◽

...

Keyword(s):

Systematic Review ◽

Heart Disease ◽

East Africa ◽

Rheumatic Heart Disease ◽

School Children ◽

Meta Analysis ◽

Rheumatic Heart

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Rheumatic heart disease in school children in Samoa

Archives of Disease in Childhood ◽

10.1136/adc.81.4.372d ◽

1999 ◽

Vol 81 (4) ◽

pp. 372-372 ◽

Cited By ~ 23

Author(s):

A. C STEER ◽

J. ADAMS ◽

J. CARLIN ◽

T. NOLAN ◽

F. SHANN

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

School Children ◽

Rheumatic Heart

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Validation of a simplified score for predicting latent rheumatic heart disease progression using a prospective cohort of Brazilian schoolchildren

BMJ Open ◽

10.1136/bmjopen-2020-036827 ◽

2020 ◽

Vol 10 (5) ◽

pp. e036827 ◽

Cited By ~ 1

Author(s):

Bárbara Martins Bechtlufft ◽

Bruno Ramos Nascimento ◽

Craig Sable ◽

Clara Leal Fraga ◽

Márcia Melo Barbosa ◽

...

Keyword(s):

Heart Disease ◽

Public Schools ◽

Rheumatic Heart Disease ◽

Heart Diseases ◽

Diagnostic Category ◽

Secondary Outcome ◽

Unfavourable Outcome ◽

History Of ◽

Rheumatic Heart

ObjectivesEchocardiographic (echo) screening is an important tool to estimate rheumatic heart disease (RHD) prevalence, but the natural history of screen-detected RHD remains unclear. The PROVAR+ (Programa de RastreamentO da VAlvopatia Reumática) study, which uses non-experts, telemedicine and portable echo, pioneered RHD screening in Brazil. We aimed to assess the mid-term evolution of Brazilian schoolchildren (5–18 years) with echocardiography-detected subclinical RHD and to assess the performance of a simplified score consisting of five components of the World Heart Federation criteria, as a predictor of unfavourable echo outcomes.SettingPublic schools of underserved areas and private schools in Minas Gerais, southeast Brazil.ParticipantsA total of 197 patients (170 borderline and 27 definite RHD) with follow-up of 29±9 months were included. Median age was 14 (12–16) years, and 130 (66%) were woman. Only four patients in the definite group were regularly receiving penicillin.Primary and secondary outcome measuresUnfavourable outcome was based on the 2-year follow-up echo, defined as worsening diagnostic category, remaining with mild definite RHD or development/worsening of valve regurgitation/stenosis.ResultsAmong patients with borderline RHD, 29 (17.1%) progressed to definite, 49 (28.8%) remained stable, 86 (50.6%) regressed to normal and 6 (3.5%) were reclassified as other heart diseases. Among those with definite RHD, 13 (48.1%) remained in the category, while 5 (18.5%) regressed to borderline, 5 (18.5%) regressed to normal and 4 (14.8%) were reclassified as other heart diseases. The simplified echo score was a significant predictor of RHD unfavourable outcome (HR 1.197, 95% CI 1.098 to 1.305, p<0.001).ConclusionThe simple risk score provided an accurate prediction of RHD status at 2-year follow-up, showing a good performance in Brazilian schoolchildren, with a potential value for risk stratification and monitoring of echocardiography-detected RHD.

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