Clinical outcomes for young people with screening-detected and clinically-diagnosed rheumatic heart disease in Fiji.
Engelman, Daniel;
Mataika, Reapi L;
Ah Kee, Maureen;
Donath, Susan;
Parks, Tom;
Colquhoun, Samantha M;
Carapetis, Jonathan R;
Kado, Joseph H;
Steer, Andrew C;
(2017)
Clinical outcomes for young people with screening-detected and clinically-diagnosed rheumatic heart disease in Fiji.
International journal of cardiology, 240.
pp. 422-427.
ISSN 0167-5273
DOI: https://doi.org/10.1016/j.ijcard.2017.04.004
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BACKGROUND: Echocardiographic screening is under consideration as a disease control strategy for rheumatic heart disease (RHD). However, clinical outcomes of young people with screening-detected RHD are unknown. We aimed to describe the outcomes for a cohort with screening-detected RHD, in comparison to patients with clinically-diagnosed RHD. METHODS: A retrospective cohort study included all young people with screening-detected RHD in the Central Division of Fiji in the primary cohort. Screen-negative and clinically-diagnosed comparison groups were matched 1:1 to the primary cohort. Data were collected on mortality, clinical complications and healthcare utilisation from the electronic and paper health records and existing databases. RESULTS: Seventy participants were included in each group. Demographic characteristics of the groups were similar (median age 11years, 69% female, median follow-up 7years). There were nine (12.9%) RHD-related deaths in the clinically-diagnosed group and one (1.4%) in the screening-detected group (Incident Rate Ratio: 9.6, 95% CI 1.3-420.6). Complications of RHD were observed in 39 (55.7%) clinically-diagnosed cases, four (20%) screening-detected cases and one (1.4%) screen-negative case. There were significant differences in the cumulative complication curves of the groups (p<0.001). Rates of admission and surgery were highest in the clinically-diagnosed group, and higher in the screening-detected than screen-negative group. CONCLUSIONS: Young people with screening-detected RHD have worse health outcomes than screen-negative cases in Fiji. The prognosis of clinically-diagnosed RHD remains poor, with very high mortality and complication rates. Further studies in other settings will inform RHD screening policy. Comprehensive control strategies are required for disease prevention.