Screening for rheumatic heart disease: is a paradigm shift required?

Area of Science:

• Cardiology
• Public Health
• Medical Diagnostics

Background:

• Rheumatic heart disease (RHD) is a significant global health burden, particularly in low-resource settings.
• Echocardiography is crucial for diagnosing RHD, but current criteria face challenges in real-world screening programs.
• The World Heart Federation (WHF) provides guidelines for echocardiographic diagnosis of RHD.

Purpose of the Study:

• To critically appraise the performance of WHF echocardiographic criteria for RHD diagnosis in African screening programs.
• To identify logistical and methodological issues affecting current RHD screening guidelines.
• To explore and propose novel screening methodologies for subclinical RHD.

Main Methods:

• Focused review of existing literature and screening program data.
• Critical analysis of the WHF criteria's application in African RHD screening.
• Exploration of alternative echocardiographic screening approaches.

Main Results:

• Current WHF criteria exhibit performance limitations in African RHD screening programs due to logistical and methodological challenges.
• Existing guidelines may not adequately capture subclinical RHD in diverse populations.
• Specific shortcomings in guideline implementation were identified.

Conclusions:

• The performance of current WHF echocardiographic criteria for RHD diagnosis needs improvement in African screening settings.
• Novel screening methodologies are required to address identified shortcomings.
• Adoption of new approaches could necessitate a paradigm shift in diagnosing subclinical RHD.