Echo screening for RHD among school children aids timely detection and treatment
Rheumatic heart disease (RHD) causes more than 10 million disability-adjusted life-years every year, accounting for most deaths from valvular heart disease worldwide. In a recent study, researchers have found that early detection of clinically silent rheumatic heart disease and timely initiation of secondary antibiotic prophylaxis is an effective approach to control rheumatic heart disease in endemic regions. The research has been published in the JAMA Cardiology on January 20, 2021.
The burden of RHD is disproportionately prevalent in marginalized communities across sub-Saharan Africa, South Asia, and the Pacific Islands, where endemic patterns of disease prevail. A previous cross-sectional study using echocardiographic screening for RHD in Nepal found that 10 per 1000 children had evidence of RHD with 4 of 5 cases being latent. Early detection of subclinical stages of RHD and timely initiation of secondary antibiotic prophylaxis for the latent disease may reverse subclinical valvular lesions, prevent disease progression, and contain the reservoir for further spread. There is, however, no randomized evidence available to support this notion. Therefore, researchers conducted a study to investigate the effectiveness of systematic echocardiographic screening in combination with secondary antibiotic prophylaxis on the prevalence of rheumatic heart disease.
It was a cluster-randomized controlled study that included 35 schools in urban and rural areas of the Sunsari district in Nepal. Researchers evaluated students of 9 to 16 years who were attending public and private schools. They performed Echocardiographic follow-up between January 7, 2016, and January 3, 2019. Children who underwent systematic echocardiographic screening followed by secondary antibiotic prophylaxis in case they had echocardiographic evidence of latent rheumatic heart disease were included in the experimental group. Children who underwent no echocardiographic screening were included in the control group. The major outcome assessed was the prevalence of the composite of definite or borderline rheumatic heart disease, according to the World Heart Federation criteria in experimental and control schools as assessed 4 years after intervention.
Key findings of the study were:
• After a median of 4.3 years, researchers have noted, 17 of 19 schools in the experimental group (2648 children) and 15 of 16 schools in the control group (1325 children) underwent echocardiographic follow-up.
• They found that the prevalence of definite or borderline rheumatic heart disease was 10.8 per 1000 children in the control group and 3.8 per 1000 children in the experimental group with the risk of developing RHD by 0.34.
• They also found that the prevalence in the experimental group at baseline was 12.9 per 1000 children and the risk of RHD had dropped significantly by the follow-up (OR, 0.29).
The authors concluded, "School-based echocardiographic screening in combination with secondary antibiotic prophylaxis in children with evidence of latent rheumatic heart disease may be an effective strategy to reduce the prevalence of definite or borderline rheumatic heart disease in endemic regions".
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