Experts from countries most affected by rheumatic heart disease (RHD) met this weekend to develop a standardised approach to diagnosis of the disease using echocardiography (ultrasound) at the International Standardisation of Echocardiographic diagnosis of RHD Workshop in Bangkok, Thailand.
"Doctors have known for many years that echocardiography is better than using a stethoscope to detect acute heart damage in patients with rheumatic fever," said Dr. Nigel Wilson, Starship Children's Hospital, Auckland, New Zealand. "But until now we have not been able to say clearly how echocardiography should be used to diagnose the chronic RHD that arises from rheumatic fever. These machines are so sensitive that they allow us to detect abnormalities that may not cause any symptoms or heart murmurs - the challenge is to be sure that we all agree on what constitutes RHD in these milder cases."
The consensus reached during the meeting will be used to develop guidelines for physicians around the world that face significant challenges in diagnosing RHD early.
"By creating guidelines for the echocardiographic diagnosis of RHD we are moving towards agreed approaches to screening children for RHD in developing countries," said Dr. Jonathan Carapetis, World Heart Federation expert on RHD and Director of the Menzies School of Health Research in Darwin, Australia. "RHD affects millions of people in countries where echocardiographic screening is not routinely carried out. It is possible that screening could help to identify RHD much earlier and thereby reduce the long-term serious consequences of this devastating disease."
About RHD
RHD is a chronic heart condition caused by rheumatic fever that can be prevented and controlled. Rheumatic fever is caused by a preceding group A streptococcal (strep) infection. Treating strep throat with antibiotics can prevent rheumatic fever. Moreover, regular antibiotics (usually monthly injections) can prevent patients with rheumatic fever from contracting further strep infections and causing progression of valve damage.
RHD is a substantial global health problem that can result in irreversible heart damage and death. It occurs predominately in developing countries and is also common in poorer populations in middle-income countries (e.g. Brazil, India) and some indigenous populations in wealthy countries (Australia, New Zealand). RHD will continue to be a global problem unless current prevention initiatives are expanded and sustained.
Previous estimates state that more than 15 million people have RHD and that 350,000 people die each year while many more are left disabled.[i] But a recent study from Nicaragua has suggested that these data may underestimate the number of people with the disease by a factor of four to five. This means that between 62 million and 78 million individuals worldwide may currently have RHD, which could potentially result in 1.4 million deaths per year from RHD and its complications.[ii]
References
[i] Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis 2005; 5:685-694.
[ii] Paar JA, Berrios NM, Rose JD et al. Prevalence of Rheumatic Heart Disease in Children and Young Adults in Nicaragua. Am J Cardiol 2010;105:1809-1814.
Source
World Heart Federation