Abstract
We aimed to use echocardiographic (echo) screening to evaluate the risk of Rheumatic Heart Disease (RHD) among the relatives of patients with advanced RHD, who were enrolled in the University Hospital’s outpatient clinics from February 2020 to September 2021. Consenting first-degree relatives were invited for echo screening using handheld devices (GE VSCAN) by non-physicians, with remote interpretation. Matched controls (spouses, neighbors) living in the same household were enrolled in a 1:5 fashion. A standard echo (GE Vivid-IQ) was scheduled if abnormalities were observed. In 16 months, 226 relatives and 47 controls of 121 patients were screened, including 129 children, 77 siblings and 20 parents. The mean age was 40 ± 17 years, 67% of the patients were women, and 239 (88%) lived with the index case for >10 years. Echo findings suggestive of RHD were confirmed in zero controls and 14 (7.5%) relatives (p = 0.05): 11 patients had mild/moderate mitral regurgitation, and four were associated with mitral stenosis and abnormal morphology. Two patients had mild aortic regurgitation and abnormal morphology, which were associated with mild aortic and mitral stenosis, and two patients with advanced RHD had bioprostheses in the mitral (2) and aortic (1) positions. In conclusion, first-degree relatives of individuals with clinical RHD are at greater risk of having RHD, on top of socioeconomic conditions.
Highlights
The global burden of Rheumatic Heart Disease (RHD) is still high, and among cardiovascular diseases, it accounts for 1.6% of all deaths, resulting in 306,000 deaths yearly worldwide [1]
The optimization of active case finding strategies is of the utmost importance, in order to better define individuals who are at high risk, and to guide diagnostic approaches
70.8% reported the past prescription of Benzathine Penicillin B (BPG), but only 21.1% were currently under prescription
Summary
The global burden of Rheumatic Heart Disease (RHD) is still high, and among cardiovascular diseases, it accounts for 1.6% of all deaths, resulting in 306,000 deaths yearly worldwide [1]. In Brazil, valvular dysfunction from RHD is responsible for nearly 50% of valve surgeries in the public health system [2] It is noticeable, that the age-standardized prevalence of RHD showed a stable pattern from 1990 to 2019, and a remarkable 59% reduction of age-standardized mortality was observed [1]. That the age-standardized prevalence of RHD showed a stable pattern from 1990 to 2019, and a remarkable 59% reduction of age-standardized mortality was observed [1] This resulted from socioeconomic development, and reflects the expansion of the public health system and improved access to basic RHD care (e.g., the treatment of pharyngitis and acute rheumatic fever, primary and secondary prophylaxis, and clinical follow-up), provided at the primary level. The optimization of active case finding strategies is of the utmost importance, in order to better define individuals who are at high risk, and to guide diagnostic approaches
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