Abbreviated Echocardiographic Screening for Rheumatic Heart Disease by Nonexperts with and without Offsite Expert Review: A Diagnostic Accuracy Study

Francis, Joshua; Fairhurst, Helen; Yan, Jennifer; Monteiro, Anferida Fernandes; Lee, Anne-Marie; Maurays, Joaquina; Kaethner, Alex; Whalley, Gillian; Hardefeldt, Hilary; Williamson, Jacqui; Marangou, James; Reeves, Ben; Wheaton, Gavin; Robertson, Terry; Horton, Ari; Cush, James; Wade, Vicki; Monteiro, André; Draper, Anthony; Morris, Peter S.; Ralph, Anna P.; Reményi, Bo

doi:10.1016/j.echo.2023.02.007

Cited by 11 publications

(10 citation statements)

References 41 publications

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“…Similarly high prevalence of non-rheumatic cardiac abnormalities could be anticipated in other resource-limited settings where RHD and high NCD burden coexist. To date, non-rheumatic abnormalities have only been described in a new Caledonian RHD screening study, where a similar spectrum of abnormalities to those found in NZ were noted,7 and more recently, in Northern Australia and Timor-Leste, where the prevalence of congenital abnormalities was around 2% 12 13. This may be due to limited capacity for detailed echocardiography reporting by expert cardiologists in many settings where RHD echocardiographic studies have been conducted.…”

Section: Discussionmentioning

confidence: 99%

“…Until recently, only a few population-based echocardiographic screening studies have examined adolescents and young adults,6–10 and these were conducted prior to the publication and subsequent widespread adoption of the World Heart Federation (WHF) consensus diagnostic criteria for RHD in 2012 11. Two more contemporary studies in Northern Australia and Timor-Leste have evaluated cohorts which included children and adolescents up to the age of 20 years, using abbreviated imaging protocols 12 13. The natural history of recurrent acute rheumatic fever (ARF) progressing to chronic RHD is such that the majority of global RHD burden occurs in adults.…”

Section: Introductionmentioning

confidence: 99%

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High burden of rheumatic heart disease confirmed by echocardiography among Pacific adults living in New Zealand

et al. 2023

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BackgroundDespite numerous echocardiographic screening studies of children in high incidence acute rheumatic fever (ARF)/rheumatic heart disease (RHD) communities, little is known about the prevalence of RHD in adults in these populations.We sought to determine the prevalence of RHD in an urban area of South Auckland, New Zealand, where previous studies had shown the prevalence of RHD in children to be around 2%.MethodsA cross-sectional screening study was conducted between 2014 and 2016. Echocardiography clinics were conducted at an urban Pacific-led primary healthcare clinic in New Zealand. Eligible persons aged 16–40 years were recruited according to a stratified randomised approach. Echocardiograms were performed with a standardised image acquisition protocol and reported by cardiologists.ResultsThere were 465 individuals who underwent echocardiograms. The overall prevalence of RHD (define and borderline) was 56 per 1000 (95% CI 36 to 78 per 1000). Definite RHD was found in 10 individuals (4 of whom were already under cardiology review at a hospital clinic) with a prevalence of 22 per 1000 (95% CI 9 to 36 per 1000). Non-rheumatic cardiac abnormalities were found in 29 individuals.ConclusionsThere is a high burden of both rheumatic and non-rheumatic cardiac abnormalities in this population. Rates described in New Zealand are as high as lower-middle-income countries in Africa. Addressing knowledge gaps regarding the natural history of RHD detected by echocardiography in adults is a priority issue for the international RHD community.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High burden of rheumatic heart disease confirmed by echocardiography among Pacific adults living in New Zealand

et al. 2023

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“…As a result of these considerations, multiple researchers have tested alternatives, including using less expensive machines (e.g. handheld or portable), having trained non-experts obtain the images and using remote expert review ( 17 , 18 ).…”

Section: Different Approaches To Echocardiographic Screeningmentioning

confidence: 99%

“…Furthermore, training non-experts to obtain images (e.g. nurses and general practitioners) has been found to be an option for echocardiographic screening ( 17 , 20 ). Recently, Francis et al compared two different approaches to using echocardiography to identify RHD (i.e.…”

Section: Different Approaches To Echocardiographic Screeningmentioning

confidence: 99%

“…Recently, Francis et al compared two different approaches to using echocardiography to identify RHD (i.e. echocardiography performed by a non-expert with subsequent referral of abnormal cases versus echocardiography performed by a non-expert with the image reviewed by an expert remotely) and found that both had similar sensitivity, but specificity was significantly improved with remote expert review ( 17 ).…”

Section: Different Approaches To Echocardiographic Screeningmentioning

confidence: 99%

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The role of echocardiographic screening in reducing the burden of rheumatic heart disease in Latin America

Urina-Jassir,

Jaimes-Reyes,

Urina-Jassir

et al. 2023

Revista Panamericana De Salud Pública

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The objectives of this article are to reflect on the rationale behind the use of echocardiographic screening for rheumatic heart disease and to provide key recommendations about steps needed to implement and improve echocardiographic screening programs in Latin America. Rheumatic heart disease remains a public health problem affecting mainly low-income and lower-middle-income countries and populations. Latin America is an area with economic inequalities, and the epidemiology of rheumatic heart disease remains largely unknown. Echocardiographic screening is useful for updating the epidemiology and providing early diagnosis of the disease. We discuss different approaches used in successful echocardiographic screening programs worldwide and in Latin America. We then identify the key elements needed to establish successful echocardiographic screening programs in Latin America, including increased awareness and involvement from multiple sectors (e.g. the community, health care professionals, scientific organizations and public health entities), identification of areas in need, development of a plan and structure that include different screening approaches, and how to ensure appropriate follow up for those who screen positive.

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Echocardiographic Screening for Rheumatic Heart Disease: A Brief History and Implications for the Future

Williamson,

Remenyi,

Francis

et al. 2024

Heart, Lung and Circulation

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Abbreviated Echocardiographic Screening for Rheumatic Heart Disease by Nonexperts with and without Offsite Expert Review: A Diagnostic Accuracy Study

Cited by 11 publications

References 41 publications

High burden of rheumatic heart disease confirmed by echocardiography among Pacific adults living in New Zealand

High burden of rheumatic heart disease confirmed by echocardiography among Pacific adults living in New Zealand

The role of echocardiographic screening in reducing the burden of rheumatic heart disease in Latin America

Echocardiographic Screening for Rheumatic Heart Disease: A Brief History and Implications for the Future

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