Echocardiographic screening for subclinical rheumatic heart disease remains a research tool pending studies of impact on prognosis
Current Cardiology Reports
Division of Paediatric Cardiology, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa; Department of Medicine, Old Groote Schuur Hospital, Groote Schuur Drive, Observatory, 7945, Cape Town, South Africa
The application of portable echocardiography to the screening of asymptomatic children and young adults for rheumatic heart disease (RHD) in developing countries indicates that the disease may affect 62 million to 78 million individuals worldwide, which could potentially result in 1.4 million deaths per year from RHD and its complications. The World Heart Federation has developed a guideline for the echocardiographic diagnosis of RHD in asymptomatic individuals without a history of acute rheumatic fever (ARF) in order to ensure the reliability, comparability, and reproducibility of findings of the echocardiographic screening studies. Early studies suggest that a third of individuals with asymptomatic subclinical RHD revert to normal echocardiographic findings on repeat testing after 6-12 months, suggesting that repeat echocardiography may be necessary to confirm the findings prior to consideration of interventions such as antibiotic prophylaxis. It is not known, however, whether echocardiographic screening for asymptomatic subclinical RHD or the introduction of antibiotic prophylaxis for affected individuals improves the prognosis of RHD. Furthermore, the cost-effectiveness of this screening method has not been established in the vast majority of affected countries. Therefore, echocardiographic screening for asymptomatic subclinical RHD remains a research tool until studies of impact on prognosis and cost-effectiveness are conducted. © Springer Science+Business Media New York 2013.
antibiotic prophylaxis; article; asymptomatic disease; clinical protocol; comparative effectiveness; cost effectiveness analysis; developing country; disease activity; disease classification; disease course; disease surveillance; echocardiography; health care cost; human; practice guideline; prognosis; reliability; repeat procedure; reproducibility; rheumatic heart disease