Rheumatic heart disease screening

Abstract

Rheumatic heart disease (RHD) is a disease of poverty, is almost entirely preventable, and is the most common cardiovascular disease worldwide in those under 25 years. RHD is caused by acute rheumatic fever (ARF) which typically results in cumulative valvular lesions that may present clinically after a number of years of subclinical disease. Therapeutic interventions, therefore, typically focus on preventing subsequent ARF episodes (with penicillin prophylaxis). However, not all patients with ARF develop symptoms and not all symptomatic cases present to a physician or are correctly diagnosed. Therefore, if we hope to control ARF and RHD at the population level, we need a more reliable discriminator of subclinical disease. Recent studies have examined the utility of echocardiographic screening, which is far superior to auscultation at detecting RHD. However, there are many concerns surrounding this approach. Despite the introduction of the World Heart Federation diagnostic criteria in 2012, we still do not really know what constitutes the most subtle changes of RHD by echocardiography. This poses serious problems regarding whom to treat and what to do with the rest, both important decisions with widespread implications for already stretched health-care systems. In addition, issues ranging from improving the uptake of penicillin prophylaxis in ARF/RHD-positive patients, improving portable echocardiographic equipment, understanding the natural history of subclinical RHD and how it might respond to penicillin, and developing simplified diagnostic criteria that can be applied by nonexperts, all need to be effectively tackled before routine widespread screening for RHD can be endorsed.

Lessening burden of rheumatic heart disease in Saint Vincent and the Grenadines

“…8 The prevention of the transmission of Group A Streptococcal bacteria is of upmost importance as the long-term sequela of Group A Streptococcal bacterial infection, or more commonly known as Strep throat, is rheumatic heart disease. 2 Children appear to be especially vulnerable to Streptococcal infection because the Group A Streptococcal bacteria is highly contagious (Mayo Foundation for Medical Education and Research, 2018). This bacteria can spread through respiratory droplets when a child coughs or sneezes, as two examples.…”

“…Penicillin prophylaxis has been successfully utilized, in conjunction with register-based rheumatic heart disease control programs in Australia, Egypt, Taiwan, Brazil, Uganda, and South Africa. 2 Penicillin prophylaxis has shown to be advantageous because it slows the progression of strep throat and acute rheumatic fever to rheumatic heart disease. Moreover, Group A Streptococcus has not demonstrated any antimicrobial resistance against penicillin.…”

“…Echocardiograms have become rather compact and portable; moreover, probes can be attached to "smart devices" which will continue to increase portability and reduce initial costs for the product. 2 In addition, there are larger, more cumbersome model that are available as well.…”

“…Sensitivity for definite RHD was high at 86.7%-93.3%". 2 With proper training, Saint Vincent and the Grenadines can have specialists train nurses and other health workers in the most remote islands to be able to utilize echocardiograms to properly screen for rheumatic heart disease.…”

“…Rheumatic heart disease proves to be a major public health concern as is inflicts disability and premature death upon those diagnosed with it. 2 Social determinants of health largely influence whether a vulnerable population will be cured or left with a life-long burden of this disease. 1 With access to proper health screening resources, healthcare systems of low and middle-income countries can properly screen for this disease and provide the simple and inexpensive treatment of Penicillin G. Saint Vincent and the Grenadines, a thirty-two-island nation in the West Indies, has incidence of rheumatic heart disease close to 200 times that of the United States.…”