Rheumatic Heart Disease in Europe: Insights from a Pilot Screening Study and a Scoping Review

Area of Science:

• Cardiology
• Public Health
• Migrant Health

Background:

• Rheumatic heart disease (RHD) is a preventable cardiovascular disease disproportionately affecting disadvantaged populations.
• RHD persists in low- and middle-income countries and may be underrecognized in European migrants from endemic regions.
• Systematic surveillance data for RHD in Europe are lacking, particularly among migrant populations.

Purpose of the Study:

• To explore the implementation and diagnostic yield of echocardiographic screening for RHD in a migrant population in Europe.
• To contextualize screening findings through a scoping review of European RHD research.
• To assess the potential for early detection and inform future surveillance strategies for RHD in at-risk migrant groups.

Main Methods:

• A single-center pilot study screened 150 recently-arrived migrants (aged 5-26 years) from RHD-endemic regions using World Heart Federation (WHF) echocardiographic criteria.
• Medical history was documented for all screened participants.
• A scoping literature review of European studies on RHD published since 2000 was conducted following Cochrane and PRISMA guidelines.

Main Results:

• Ten percent (6.8%) of screened migrants exhibited echocardiographic abnormalities requiring further evaluation, with mitral regurgitation being most common; none had a prior RHD diagnosis.
• Screening was integrated into routine health examinations without workflow disruption.
• The scoping review identified 86 publications, revealing fragmented research, methodological heterogeneity, limited prevalence data, and a focus on surgical management over early detection.

Conclusions:

• Systematic echocardiographic screening in high-risk migrant populations can identify individuals with potential RHD abnormalities.
• Fragmented European literature and lack of multicenter studies highlight the need for harmonized surveillance and RHD burden assessment.
• Targeted screening approaches integrated into migrant health programs are needed to inform future epidemiologic and implementation research for RHD.