Effectiveness of systematic echocardiographic screening for rheumatic heart disease in Nepal
Between 2012 and 2019, we performed a cluster randomized clinical trial to investigate the effectiveness of systematic echocardiographic screening for latent rheumatic heart disease in schoolchildren in Nepal.
In a previous cross-sectional study of 5178 children from randomly selected schools in Nepal, 10 per 1000 children had evidence of rheumatic heart disease, which was clinically silent in 4 out of 5 cases. Early detection of clinically silent stages of rheumatic heart disease in combination with timely initiation of secondary antibiotic prophylaxis for latent disease may reverse subclinical valvular lesions, prevent disease progression, and contain the reservoir for further spread.
Therefore we randomly allocated 35 schools in Nepal to an experimental arm with systematic echocardiographic screening of all children 5 to 12 years of age, or a control arm with no screening. Children found to have evidence of definite rheumatic heart disease were started on secondary antibiotic prophylaxis. After a median of 4.3 years, 17 out of 19 schools in the experimental arm and 15 out of 16 schools in the control arm underwent echocardiographic follow-up, including 2648 and 1325 children, respectively.
The findings or our cluster randomized clinical trial provide for the first time some evidence that systematic school-based echocardiographic screening in combination with secondary antibiotic prophylaxis in children found to have evidence of latent rheumatic heart disease may be an effective strategy to reduce the prevalence of rheumatic heart disease in endemic regions. Furthermore, our findings underscore that - even if rheumatic heart disease accounts for the highest numbers of death from valvular heart disease worldwide - rheumatic heart disease is a preventable disease. DOI: 10.1001/jamacardio.2020.7050