Adapted echocardiography screening methods for prevention of rheumatic heart disease in Sub-Saharan Africa: a systematic review

Abstract

Echocardiography is the current gold standard used in diagnosing rheumatic heart disease and its associated sequelae, but utilization is currently limited in resource-poor settings. Decentralized diagnostic methods in these areas are crucial to improving cardiac health outcomes. A systematic review was undertaken to evaluate the diagnostic performance of adapted echocardiography screening methods in countries of sub-Saharan Africa. A literature search was conducted via the PubMed, Embase, and African Healthline databases. Studies were included in the review if they assessed the diagnostic accuracy of an adapted screening method as compared to the reference standard of hospital-based echocardiogram by trained cardiologists. Diagnostic performances of handheld echocardiography and task-shifting to non-physician roles, were assessed. For HAND techniques, the pooled sensitivity, specificity and diagnostic odds ratio was 81.2%, 91.7%, and 48.01% respectively. Task-shifting and simplified protocol diagnostic performance was also analyzed; pooled sensitivity, specificity and diagnostic OR was 74.8%, 89.5%, and 25.37% respectively. This review demonstrates strong specificity with moderate sensitivity among both methods of adapted screening. HAND methods using the standard prescribed WHO protocol had stronger diagnostic performance overall. These studies present a first step towards validating current echocardiographic screening criteria using hand-held machines and establishing training of non-physicians to conduct screening in low-resource settings.