Abstract 10180: Clinical and Subclinical Rheumatic Heart Disease Among Adults in the Amazon Basin: A Cross-Sectional Study

Abstract

Introduction: Rheumatic heart disease (RHD) remains a significant cause of morbidity and mortality in middle- and low-income countries. However, the prevalence of RHD is often underestimated in resource limited areas due to lack of proper screening programs. Purpose: We aimed to determine the prevalence of clinical and subclinical RHD among adults in the Northwestern part of the Amazon Basin, Brazil. In addition, we evaluated the diagnostic yield of a history of self-reported rheumatic fever (RF) and cardiac auscultation Methods: We included a probability sample of adults from the general population in the Amazon Basin. Participants underwent questionnaire on medical history, cardiac auscultation and echocardiography. Participants were assessed according to the 2012 World Heart Federation (WHF) Criteria for echocardiographic diagnosis of RHD (Figure A) Results: We included a total of 591 participants (mean age 41+/-15 years, 60% women, 5% <20 years old). 3% (n=19) had definite RHD (age 50 [IQR 29-70] years, 53% women) and <1% (n=2) had borderline RHD. The distribution of definite RHD according to the WHF Criteria 2012 was: A (n=8), B (n=3), C (n=0), D (n=8). Valve pathologies are displayed in Figure B. Among definite RHD cases, 16% (n=3) were considered clinical (prevalence ~1%) and 84% (n=16) were subclinical (prevalence ~3%). A self-reported history of RF had a sensitivity of 3% and a specificity of 92% (PPV 2%/ NPV 95%) to detect RHD, whereas cardiac auscultation had a sensitivity of 38% and a specificity of 80% (PPV 5%/ NPV 97%). When combining a self-reported history of RF with cardiac auscultation, this yielded a sensitivity of 3% and a specificity of 98% (PPV 10%/ NPV 96%) Conclusions: By applying the 2012 WHF Criteria, the prevalence of clinical and subclinical RHD in adults from the Northwestern part of the Amazon Basin was 1% and 3%, respectively. A combination of a self-reported history of RF and cardiac auscultation provided low sensitivity but high specificity for RHD.