This pilot RHD screening program was associated with poorer child and carer QOL for those with potentially abnormal results, greater health provider workload and suboptimal clinical follow-up. The adoption of screening for RHD in high-risk populations should be approached cautiously. Further research is required to facilitate and validate improved echocardiographic diagnostic criteria for RHD and the systematic assessment of the benefits and adverse effects of such screening.

Rheumatic heart disease is preventable but causes significant morbidity and mortality in Aboriginal Australian and Torres Strait Islander populations. Screening echocardiography has the potential to detect early rheumatic heart disease thereby enabling timely commencement of treatment (secondary prophylaxis) to halt disease progression. However, a number of issues prevent echocardiographic screening for rheumatic heart disease satisfying the Australian criteria for acceptable screening programs. Primarily, it is unclear what criteria should be used to define a positive screening result as questions remain regarding the significance, natural history and potential treatment of early and subclinical rheumatic heart disease. Furthermore, at present the delivery of secondary prophylaxis in Australia remains suboptimal such that the potential benefits of screening would be limited. Finally, the impact of echocardiographic screening for rheumatic heart disease on local health services and the psychosocial health of patients and families are yet to be ascertained.