Abstract
Background: Rheumatic heart disease (RHD) is the leading cause of cardiac death in children, posing a significant burden to health systems, particularly in developing countries. Echocardiogram is a sensitive tool to identify early RHD patients, who may benefit from secondary prevention. Therefore, we performed an updated meta-analysis to determine the prevalence of latent RHD using echocardiogram-based screening performed in endemic regions across the globe. Methods: PubMed, Embase, Cochrane, and Lilacs databases were searched for cross-sectional studies reporting the prevalence of RHD in individuals aged 5-20 years, through echocardiogram-based screening programs in endemic areas. Studies with screening based on auscultation were excluded. Echocardiography-detected RHD was considered as borderline or definite by World Heart Federation (WHF) criteria and possible, probable or definite by World Heart Organization (WHO) criteria. We used random-effects models to assess the prevalence of RHD according to the geographic distribution. Results: A total of 57 studies were included, with a total of 224,100 screened subjects. WHF criteria for RHD echocardiographic diagnosis were used in 46 studies, WHO criteria in 6, and others in 3. The overall prevalence of echocardiography detected RHD was 23 per 1,000 individuals (95% CI 18 to 29 per 1,000), with a pooled prevalence of definitive RHD of 9 per 1,000 individuals (95% CI 7 to 12 per 1,000). Analysis of the prevalence of echocardiography detected RHD in different continents yielded an overall prevalence of 21 per 1,000 (95% CI 14 to 31 per 1,000) in Africa, 28 per 1,000 (95% CI 18 to 42 per 1,000) in Oceania, 21 per 1,000 (95% CI 15 to 30 per 1,000) in Asia, and 22 per 1,000 (95% CI 6 to 76 per 1,000) in Latin America. Conclusion: Screening programs incorporating echocardiography found a significant prevalence of RHD, in the range of 20 to 30 per 1,000 children and adolescents screened in endemic areas across different continents.
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