Rheumatic fever: the potential advantages of technology

This article sets out the clinical context of the research presented by Carapetis et al. in an accompanying article in this issue. No screening guidelines exist for early detection of rheumatic heart disease (RHD). The lack of agreed diagnostic criteria is one of the reasons why large proportions of cases in resource poor nations go untreated and are detected only when the disease has progressed to cardiac failure. Here, Poole-Wilson and Seth discuss the study carried out by Jonathan Carapetis and colleagues-a cross-sectional screening protocol in Tongan primary school children. The protocol designed by Carapetis et al. identified the highest echocardiographically confirmed prevalence of RHD reported to date. Poole-Wilson and Seth explore how modern technology, in the shape of portable echocardiography, can help to move the focus on rheumatic heart disease away from epidemiology and crude preventive programs, and towards screening programs that can effectively identify people who should receive treatment before cardiac failure occurs.