Echocardiographic screening for rheumatic heart disease in high and low risk Australian children

Roberts, Kathryn, Maguire, Graeme, Brown, Alex, Atkinson, David, Reményi, Bo, Wheaton, Gavin, Kelly, Andrew, Kumar, Raman K., Su, Jiunn-Yih, and Carapetis, Jonathan R. (2014) Echocardiographic screening for rheumatic heart disease in high and low risk Australian children. Circulation, 129 (19). pp. 1953-1961.

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Abstract

Background: Echocardiographic screening for rheumatic heart disease (RHD) is becoming more widespread, but screening studies to date have used different echocardiographic definitions. The World Heart Federation has recently published new criteria for the echocardiographic diagnosis of RHD. We aimed to establish the prevalence of RHD in high-risk Indigenous Australian children using these criteria and to compare the findings with a group of Australian children at low risk for RHD.

Methods and Results: Portable echocardiography was performed on high-risk Indigenous children aged 5 to15 years living in remote communities of northern Australia. A comparison group of low-risk, non-Indigenous children living in urban centers was also screened. Echocardiograms were reported in a standardized, blinded fashion. Of 3946 high-risk children, 34 met World Heart Federation criteria for definite RHD (prevalence, 8.6 per 1000 [95% confidence interval, 6.0–12.0]) and 66 for borderline RHD (prevalence, 16.7 per 1000 [95% confidence interval, 13.0–21.2]). Of 1053 low-risk children, none met the criteria for definite RHD, and 5 met the criteria for borderline RHD. High-risk children were more likely to have definite or borderline RHD than low-risk children (adjusted odds ratio, 5.7 [95% confidence interval, 2.3–14.1]; P<0.001).

Conclusions: The prevalence of definite RHD in high-risk Indigenous Australian children approximates what we expected in our population, and no definite RHD was identified in the low-risk group. This study suggests that definite RHD, as defined by the World Heart Federation criteria, is likely to represent true disease. Borderline RHD was identified in children at both low and high risk, highlighting the need for longitudinal studies to evaluate the clinical significance of this finding.

Item ID: 37825
Item Type: Article (Research - C1)
ISSN: 1524-4539
Keywords: echocardiography, pediatrics, rheumatic heart disease, mass screening
Funders: Australian Government , Children First Foundation, Kiwanis Clubs of Australia, Cabrini Health, Charles Darwin University, National Health and Medical Research Council (NHMRC), Margaret Ross Chair in Indigenous Health
Date Deposited: 21 May 2015 02:23
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1102 Cardiovascular Medicine and Haematology > 110201 Cardiology (incl Cardiovascular Diseases) @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920103 Cardiovascular System and Diseases @ 100%
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