• Joshua R Francis, Helen Fairhurst, Hilary Hardefeldt, Shannon Brown, Chelsea Ryan, Kurt Brown, Greg Smith, Roz Baartz, Ari Horton, Gillian Whalley, James Marangou, Alex Kaethner, Anthony Dk Draper, Christian L James, Alice G Mitchell, Jennifer Yan, Anna Ralph, and Bo Remenyi.
• Menzies School of Health Research, Charles Darwin University, Darwin, NT.
• Med. J. Aust. 2020 Aug 1; 213 (3): 118123118-123.

ObjectivesUsing echocardiographic screening, to estimate the prevalence of rheumatic heart disease (RHD) in a remote Northern Territory town.DesignProspective, cross-sectional echocardiographic screening study; results compared with data from the NT rheumatic heart disease register.Setting, ParticipantsPeople aged 5-20 years living in Maningrida, West Arnhem Land (population, 2610, including 2366 Indigenous Australians), March 2018 and November 2018.InterventionEchocardiographic screening for RHD by an expert cardiologist or cardiac sonographer.Main Outcome MeasuresDefinite or borderline RHD, based on World Heart Federation criteria; history of acute rheumatic fever (ARF), based on Australian guidelines for diagnosing ARF.ResultsThe screening participation rate was 72%. The median age of the 613 participants was 11 years (interquartile range, 8-14 years); 298 (49%) were girls or women, and 592 (97%) were Aboriginal Australians. Definite RHD was detected in 32 screened participants (5.2%), including 20 not previously diagnosed with RHD; in five new cases, RHD was classified as severe, and three of the participants involved required cardiac surgery. Borderline RHD was diagnosed in 17 participants (2.8%). According to NT RHD register data at the end of the study period, 88 of 849 people in Maningrida and the surrounding homelands aged 5-20 years (10%) were receiving secondary prophylaxis following diagnoses of definite RHD or definite or probable ARF.ConclusionPassive case finding for ARF and RHD is inadequate in some remote Australian communities with a very high burden of RHD, placing children and young people with undetected RHD at great risk of poor health outcomes. Active case finding by regular echocardiographic screening is required in such areas.© 2020 AMPCo Pty Ltd.

29 keywords...

hide…