Prevalence and outcome of subclinical rheumatic heart disease in India: The RHEUMATIC (Rheumatic Heart Echo Utilisation and Monitoring Actuarial Trends in Indian Children) study

Saxena, Anitá; Ramakrishnan, Sivasubramanian; Roy, Ambuj; Seth, Sandeep; Krishnan, Anand; Misra, Puneet; Kalaivani, Mani; Bhargava, Balram; Flather, Marcus; Poole-Wilson, Philip

doi:10.1136/heartjnl-2011-300792

Cited by 165 publications

(144 citation statements)

References 16 publications

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“…The prevalence of RHD varies across the globe, the highest being in subSaharan Africa (5.7e55.4/1000 6 ) with least being in the developed nations where the prevalence is less than 1/1000. In India the prevalence of RHD as reported (Table 4) by ICMR, 9,10 Padmavathi, 11 Grover et al, 10 Avasthi et al, 12 Patel et al, 13 Jacob Jose et al 2 Periwal et al, 14 Bhaya et al 4 and Saxena et al 5 varied from 1 to 51/1000. Jacob Jose from Vellore, 2 South India screened 2, 29 829 school children aged 6e18 years.…”

Section: Discussionmentioning

confidence: 97%

Prevalence of rheumatic and congenital heart disease in school children of Andhra Pradesh, South India

Kumari

Raju

Patnaik

et al. 2013

Journal of Cardiovascular Disease Research

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Section: Discussionmentioning

confidence: 97%

Prevalence of rheumatic and congenital heart disease in school children of Andhra Pradesh, South India

Kumari

Raju

Patnaik

et al. 2013

Journal of Cardiovascular Disease Research

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“…Various other studies also revealed higher prevalence rates among females. 10,19 The present study also documented clinical complications associated with RHD. Mitral valve disease accounted for 86% of cases, aortic valve involvement was seen in 7% of cases, and both mitral and aortic valve involvement were seen in 7% cases.…”

Section: Discussionmentioning

confidence: 63%

“…4,12 In one study, clinical examination revealed only 0.8 RHD cases/1000 population, whereas echocardiography revealed 20.4 RHD cases/1000 population. 19 The reported differences in the prevalence of RHD might be due to different diagnostic methods adopted in various studies or due to non-uniformity of the populations studied. Unfortunately, there are few comparable studies in India determining the prevalence of RHD in rural communities in the above 15 years age groups.…”

Section: Discussionmentioning

confidence: 99%

“…The delay in the diagnosis of subclinical disease in the population leads to advanced stages of RHD, although all subclinical cases may not progress to clinical RHD. 19 The large number of cases (>80%) in the age group below 44 years is also a cause for concern. One significant finding of this study was 69% of the cases with past history of rheumatic fever were absent and 60% of them were not on penicillin prophylaxis (medical records were available for only 40% of the screened population).…”

Section: Discussionmentioning

confidence: 99%

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Rheumatic heart disease in rural south India: A clinico-observational study

Sriharibabu¹,

Himabindu²,

Kabir³

2013

Journal of Cardiovascular Disease Research

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a b s t r a c tBackground: Rheumatic heart disease (RHD) is still a public health issue in many countries in the world, and particularly in Southeast Asia. India, for example, contributes 25%e50% of the global burden of RHD. Clinic-based and epidemiological studies on RHD in India have used different methodologies and clinical criteria to estimate RHD burden in India. The present study employs strict clinical criteria, including echocardiography, to estimate RHD prevalence and associated clinical complications in a large unique rural population in southern India covered through a governmental health insurance scheme. Materials and methods: Total 44,164 eligible patients were screened from 238 primary care health centers in rural southern India between October 2007 and March 2012 using strict clinical criteria and objective ascertainment. A total of 403 patients aged 15 years or above were finally analyzed based on both the inclusion and exclusion criteria. Detailed information on both demographic and clinical characteristics was obtained through personal interviews and clinical examinations. Descriptive analyses were performed, including age standardization. Results: The age-standardized RHD prevalence rate was 9.7/1000 populationsdmore common in younger age groups (<44 years) and relatively high among females. Pulmonary hypertension was the most common clinical complication followed by CHF, tricuspid regurgitation, as well as infective endocarditis. More than two-thirds had no past history of RHD or penicillin prophylaxis. Conclusions: RHD rates are still high in rural India among populations covered through governmental health insurance scheme. Both primary and secondary preventive measures, including widespread coverage of penicillin prophylaxis, must be considered mainstay tools to both prevent and reduce RHD burden in endemic populations, including rural India.

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“…[11] With multiple recent international studies in Mexico and Africa using point of care ultrasound to screen patients for cardiac anomalies, there is hope that similar projects can have promising results in rural Panama. [12,13] In this project, a group of fi rst year medical students traveled to Bocas Del Toro, Panama to visualize basic cardiac anatomy on pediatric patients. Combining the explosiveness of ultrasound in medical education and the need for pediatric cardiac screenings in rural settings, our aim was to determine if minimally trained firstyear medical students were able to successfully identify pediatric cardiac anatomy and cardiac pathology in rural Panama.…”

Section: Introductionmentioning

confidence: 99%

Feasibility study of first-year medical students identifying cardiac anatomy using ultrasound in rural Panama

Miner

Purdy

Curtis

et al. 2015

World Journal of Emergency Medicine

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BACKGROUND:There are over 15 million children who have cardiac anomalies around the world, resulting in a signifi cant morbidity and mortality. Early recognition and treatment can improve the outcomes and lengthen life-expectancy of these patients. The NIH and WHO have promoted guidelines for screening for congenital cardiac anomalies using ultrasound in rural environments. METHODS:Our study took place in Bocas Del Toro, Panama where a mobile clinic was established for community healthcare screening and ultrasonographic evaluation by medical student volunteers and volunteer clinical faculty. This was a non-blinded, investigational study utilizing a convenience sample of pediatric patients presenting for voluntary evaluation. Seven fi rst-year medical students were recruited for the study. These students underwent a training program for advanced cardiac ultrasound instruction, termed "Pediatric Echocardiography Cardiac Screening (PECS)". RESULTS:Ten patients were enrolled in the study. Nine patients had adequate images as defined by the PECS criteria and were all classified as normal cardiac pathology by the medical students, resulting in a sensitivity and specifi city of 100%. A single patient was identifi ed by medical students as having a pathologic pulmonic stenosis. This was confirmed as correct by a blinded ultrasonographer. CONCLUSIONS:In this pilot study, the first-year medical students were able to correctly identify pediatric cardiac anatomy and pathology in rural Panama after undergoing a 12-hour ultrasound PECS training session. We believe that with this knowledge, minimally trained practitioners can be used to screen for cardiac anomalies in rural Panama using ultrasound.

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Prevalence and outcome of subclinical rheumatic heart disease in India: The RHEUMATIC (Rheumatic Heart Echo Utilisation and Monitoring Actuarial Trends in Indian Children) study

Cited by 165 publications

References 16 publications

Prevalence of rheumatic and congenital heart disease in school children of Andhra Pradesh, South India

Prevalence of rheumatic and congenital heart disease in school children of Andhra Pradesh, South India

Rheumatic heart disease in rural south India: A clinico-observational study

Feasibility study of first-year medical students identifying cardiac anatomy using ultrasound in rural Panama

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