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Echocardiographic screening for rheumatic heart disease in high and low risk Australian children
Kathryn Roberts1, Graeme Maguire, Alex Brown
1Menzies School of Health Research, Darwin, Northern Territory, Australia (K.R., B.R., J.-Y.S., J.R.C.); Department of Paediatrics (K.R.) and Northern Territory Cardiac Services (B.R.), Royal Darwin Hospital, Darwin, Northern Territory, Australia; Baker IDI Central Australia, Alice Springs, Northern Territory, Australia (G.M., A.B.); Cairns Clinical School, School of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia (G.M.); South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia (A.B.); School of Population Health, University of South Australia, Adelaide, Australia (A.B.); Rural Clinical School of Western Australia, University of Western Australia, Broome, Western Australia, Australia (D.A.); Kimberley Aboriginal Medical Services Council, Broome, Western Australia, Australia (D.A.); Department of Cardiology, Women's and Children's Hospital, Adelaide, South Australia, Australia (G.W., A.K.); Flinders University, Adelaide, South Australia, Australia (G.W.); Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India (R.K.K.); Centre for Disease Control, Department of Health, Darwin, Northern Territory, Australia (J.-Y.S.); Telethon Kids Institute, University of Western Australia, Perth, Australia (J.R.C.).
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 to 15 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.
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