Abstract
BackgroundThe objective of the study was to evaluate the implications of different classifications of rheumatic heart disease on estimated prevalence, and to systematically assess the importance of incidental findings from echocardiographic screening among schoolchildren in Peru.MethodsWe performed a cluster randomized observational survey using portable echocardiography among schoolchildren aged 5 to 16 years from randomly selected public and private schools in Arequipa, Peru. Rheumatic heart disease was defined according to the modified World Health Organization (WHO) criteria and the World Heart Federation (WHF) criteria.FindingsAmong 1395 eligible students from 40 classes and 20 schools, 1023 (73%) participated in the present survey. The median age of the children was 11 years (interquartile range [IQR] 8–13 years) and 50% were girls. Prevalence of possible, probable and definite rheumatic heart disease according to the modified WHO criteria amounted to 19.7/1000 children and ranged from 10.2/1000 among children 5 to 8 years of age to 39.8/1000 among children 13 to 16 years of age; the prevalence of borderline/definite rheumatic heart disease according to the WHF criteria was 3.9/1000 children. 21 children (2.1%) were found to have congenital heart disease, 8 of which were referred for percutaneous or surgical intervention.ConclusionsPrevalence of RHD in Peru was considerably lower compared to endemic regions in sub-Saharan Africa, southeast Asia, and Oceania; and paralleled by a comparable number of undetected congenital heart disease. Strategies to address collateral findings from echocardiographic screening are necessary in the setup of active surveillance programs for RHD.Trial RegistrationClinicalTrials.gov identifier: NCT02353663
Highlights
Rheumatic fever results from an abnormal autoimmune response to group A streptococcal pharyngitis and may progress to rheumatic heart disease (RHD) with cumulative exposure
Prevalence of RHD in Peru was considerably lower compared to endemic regions in subSaharan Africa, southeast Asia, and Oceania; and paralleled by a comparable number of undetected congenital heart disease
Strategies to address collateral findings from echocardiographic screening are necessary in the setup of active surveillance programs for RHD
Summary
Rheumatic fever results from an abnormal autoimmune response to group A streptococcal pharyngitis and may progress to rheumatic heart disease (RHD) with cumulative exposure. Eliminated in high-income countries, RHD continues to be endemic in less privileged regions of the world where it accounts for up to a quarter million premature deaths every year [1][2]. Screening echocardiography for early detection of clinically silent rheumatic heart disease (RHD) has been recommended in endemic regions of the world, where RHD accounts for up to a quarter of a million deaths every year.[3] [1] Timely installation of secondary antibiotic prophylaxis may prevent progression of subclinical lesions to severe valvular damage and heart failure mediated by cumulative exposure to streptococcal antigens. The objective of the study was to evaluate the implications of different classifications of rheumatic heart disease on estimated prevalence, and to systematically assess the importance of incidental findings from echocardiographic screening among schoolchildren in Peru
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