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Determining the Risk of Developing Rheumatic Heart Disease Following a Negative Screening Echocardiogram
Meghan Zimmerman1,2, Amy Scheel3, Alyssa DeWyer4
1Children's Hospital at Dartmouth Hitchcock, Lebanon, PA, United States.
Insights
Children previously screened negative for rheumatic heart disease (RHD) showed a trend toward reduced RHD risk and severity. This finding impacts RHD screening program design in endemic areas.
Area of Science:
- Cardiology
- Public Health
- Pediatrics
Background:
- Rheumatic heart disease (RHD) screening via echocardiograms can enable early intervention.
- Implementing RHD screening programs faces challenges, necessitating further research.
- This study is the first large-scale assessment of RHD risk in children previously screened as negative.
Purpose of the Study:
- To evaluate the risk of developing RHD in children with a history of negative echocardiogram screening.
- To compare RHD prevalence and severity between previously screened and never-screened children.
- To inform the design and implementation of RHD screening programs in high-prevalence regions.
Main Methods:
- A retrospective cohort study was conducted in Gulu, Uganda, involving school-based echocardiogram screening.
- Children aged 5-18 years were assessed, with surveys identifying those previously screened 3-5 years prior.
- Relative risk (RR) of RHD was calculated comparing previously screen-negative children (exposed) to those undergoing initial screening (unexposed).
Main Results:
- The study included 1,582 previously screened children and 73,900 initially screened children.
- New RHD prevalence was 0.6% in the exposed cohort and 1% in the unexposed cohort.
- The RR of RHD was 0.64 (95% CI 0.3-1.2), indicating a trend toward reduced risk and milder disease in previously screened children.
Conclusions:
- No statistically significant difference in RHD prevalence was found between previously screen-negative and never-screened children.
- A trend towards decreased RHD risk and severity was observed in children with prior negative echocardiograms.
- Findings have significant implications for optimizing RHD screening strategies and resource allocation in endemic areas.
Abstract:
Background: Screening echocardiograms can detect early-stage rheumatic heart disease (RHD), offering a chance to limit progression. Implementation of screening programs is challenging and requires further research. This is the first large-scale study assessing the risk of RHD among previous screen-negative children. Methods: This retrospective cohort study, conducted in Gulu, Uganda, performed school-based echo screening on children ages 5-18 years. Surveys were used to determine which children underwent initial screening 3-5 years prior. Age, gender, and disease severity were compared between cohorts. Relative risk (RR) of RHD was calculated for those with a prior screen-negative echo (exposed cohort) compared to those undergoing first screening (unexposed cohort). Results: Echo screening was completed in 75,708 children; 226 were excluded, leaving 1,582 in the exposed cohort and 73,900 in the unexposed cohort. Prevalence of new RHD was 0.6% (10/1,582) and 1% (737/73,900), in the exposed and unexposed cohorts, respectively. The RR of RHD was 0.64 (95% CI 0.3-1.2, p = 0.15), a nearly 40% reduced risk of RHD in those with a prior negative echo. There was no difference in age or gender between RHD cohorts. All cases in the exposed cohort were borderline/mild; 2.6% of cases in the unexposed cohort had moderate/severe disease. Conclusion: There was no statistical difference in RHD prevalence between previous screen-negative children and children with no prior echocardiogram, however, there was a trend toward decreased risk and severity. This information has important implications for the design of screening programs and the use of screening echocardiograms in endemic RHD regions.
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