TY - JOUR
T1 - Clinical outcomes for young people with screening-detected and clinically-diagnosed rheumatic heart disease in Fiji
AU - Engelman, Daniel
AU - Mataika, Reapi L.
AU - Ah. Kee, Maureen
AU - Donath, Susan
AU - Parks, Tom
AU - Colquhoun, Samantha M.
AU - Carapetis, Jonathan R.
AU - Kado, Joseph H.
AU - Steer, Andrew C.
PY - 2017/8
Y1 - 2017/8
N2 - 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 11. years, 69% female, median follow-up 7. years). 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.
AB - 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 11. years, 69% female, median follow-up 7. years). 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.
KW - Complications
KW - Echocardiography
KW - Mass screening
KW - Morbidity
KW - Mortality
KW - Rheumatic heart disease
KW - Survival analysis
UR - http://www.scopus.com/inward/record.url?scp=85017193307&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2017.04.004
DO - 10.1016/j.ijcard.2017.04.004
M3 - Article
C2 - 28400121
AN - SCOPUS:85017193307
SN - 0167-5273
VL - 240
SP - 422
EP - 427
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -