Determining the Risk of Developing Rheumatic Heart Disease Following a Negative Screening Echocardiogram.

Meghan Zimmerman,Andrea Beaton,Alison Tompsett,Emmy Okello,Alyssa Dewyer,Amy Scheel,Jane-Liz Nambogo,Isaac Omara Otim,Joselyn Rwebembera,Craig Sable

doi:10.3389/fcvm.2021.632621

Abstract

Background: Screening echocardiograms can detect early-stage rheumatic heart disease (RHD), offering a chance to limit progression. Implementation of screening programs is challenging and requires further research. This is the first large-scale study assessing the risk of RHD among previous screen-negative children.Methods: This retrospective cohort study, conducted in Gulu, Uganda, performed school-based echo screening on children ages 5–18 years. Surveys were used to determine which children underwent initial screening 3–5 years prior. Age, gender, and disease severity were compared between cohorts. Relative risk (RR) of RHD was calculated for those with a prior screen-negative echo (exposed cohort) compared to those undergoing first screening (unexposed cohort).Results: Echo screening was completed in 75,708 children; 226 were excluded, leaving 1,582 in the exposed cohort and 73,900 in the unexposed cohort. Prevalence of new RHD was 0.6% (10/1,582) and 1% (737/73,900), in the exposed and unexposed cohorts, respectively. The RR of RHD was 0.64 (95% CI 0.3–1.2, p = 0.15), a nearly 40% reduced risk of RHD in those with a prior negative echo. There was no difference in age or gender between RHD cohorts. All cases in the exposed cohort were borderline/mild; 2.6% of cases in the unexposed cohort had moderate/severe disease.Conclusion: There was no statistical difference in RHD prevalence between previous screen-negative children and children with no prior echocardiogram, however, there was a trend toward decreased risk and severity. This information has important implications for the design of screening programs and the use of screening echocardiograms in endemic RHD regions.

Highlights

Rheumatic Heart Disease (RHD) is a common cause of cardiovascular morbidity and mortality in children and young adults globally
In addition to the many logistic and financial barriers that exist for implementing echo screening programs in endemic regions, several knowledge gaps remain that require attention before echo screening can be recommended as public policy
This study was designed to determine the risk of RHD following one prior negative screening echo, with the hypothesis being that children with a prior negative screening echo will have lower rates of RHD detection than those never screened before

Summary

Introduction

Rheumatic Heart Disease (RHD) is a common cause of cardiovascular morbidity and mortality in children and young adults globally. Screening echocardiograms (echos) have the ability to detect RHD at earlier stages and thereby create an opportunity to prevent further advancement of disease [4,5,6]. Our study is the first to follow a large cohort of children in an RHD endemic region to determine the risk of progression from normal to abnormal, based on screening echos, over time. This study was designed to determine the risk of RHD following one prior negative screening echo, with the hypothesis being that children with a prior negative screening echo will have lower rates of RHD detection than those never screened before. Screening echocardiograms can detect early-stage rheumatic heart disease (RHD), offering a chance to limit progression. Implementation of screening programs is challenging and requires further research This is the first large-scale study assessing the risk of RHD among previous screen-negative children

Methods

Results

Discussion

Conclusion