The validation of a new epidemiological model for rheumatic heart disease: from asymptomatic to symptomatic disease

Conference item

Background: The advent of echocardiographic screening in endemic areas for rheumatic heart disease (RHD) has led to a new epidemiological pyramid-type model combining asymptomatic subclinical RHD at the base and severe RHD leading to hospital admission at the top. Objective: The aim is to provide population and hospital-based epidemiological data to support this hypothesis. Methods: Two independent studies were conducted assessing prevalence of subclinical RHD in schoolchildren, and prevalence of symptomatic RHD requir- ing hospital admission in New Caledonia. The population-based prevalence was based on systematic echocardiography screening targeting all 4th graders in the country (2008–2011). A retrospective review of all hospital charts of patients iden- tified through ICD acute rheumatic fever or RHD codes following admission at the only hospital (2008–2011). Diagnosis of RHD was based on standardized echocardiographic criteria. The exact prevalence (95% CI) of RHD was com- puted. The New Caledonian Bureau of Statistics population estimates published in 2009 were used for population denominators. Results: Among the 18,621 schoolchildren targeted by the survey (2008–2011), 15,047 where aged 9 or 10 years old. In children aged 9–10 years, 1340 (7.7%) were referred for a second opinion on non-portable equipment of which 335/1340 (23.3%) did not attend the free of charge clinic. 130 children aged 9–10 years were diagnosed with subclinical RHD. The overall prevalence of subclinical RHD was 9 per 1,000 inhabitants [95% CI 7.5–10.7]). None of the children with sub- clinical asymptomatic RHD was subsequently admitted to hospital. Eighty-four children aged 9–10 years were diagnosed with symptomatic RHD leading to hos- pital admission in 2008–2011. Prevalence of subclinical and symptomatic RHD are depicted in the Table. Conclusions: The echocardiography-based survey prevalence estimates in chil- dren aged 9–10 years were 3 to 5 fold higher than contemporary figures driven from the hospital cohort. These results are in keeping with the recently advanced model incorporating asymptomatic and symptomatic RHD. Acknowledgement/Funding: Fédération Française de Cardiologie, Fondation Lefoulon Delalande, Fondation de la Recherche Médicale, France

Authors: Mirabel, M; Tafflet, M; Noel, B; Parks, T; Braunstein, C

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Oxford University Press
• Host title: European Heart Journal
• Journal: European Heart Journal
• Volume: 37
• Issue: suppl_1
• Pages: 985–1393
• Publication date: 2016-08-30
• Acceptance date: 2016-08-01
• Event location: Rome
• DOI: 10.1093/eurheartj/ehw434
• EISSN: 1522-9645
• ISSN: 0195-668X