Hyperendemic rheumatic heart disease in a remote Australian town identified by echocardiographic screening

Objectives Using echocardiographic screening, to estimate the prevalence of rheumatic heart disease (RHD) in a remote Northern Territory town. Design Prospective, cross-sectional echocardiographic screening study; results compared with data from theNTrheumatic heart disease register. Setting, participants People aged 5-20 years living in Maningrida, West Arnhem Land (population, 2610, including 2366 Indigenous Australians), March 2018 and November 2018. Intervention Echocardiographic screening forRHDby an expert cardiologist or cardiac sonographer. Main outcome measures Definite or borderlineRHD, based on World Heart Federation criteria; history of acute rheumatic fever (ARF), based on Australian guidelines for diagnosingARF. Results The 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. DefiniteRHDwas detected in 32 screened participants (5.2%), including 20 not previously diagnosed withRHD; in five new cases,RHDwas classified as severe, and three of the participants involved required cardiac surgery. BorderlineRHDwas diagnosed in 17 participants (2.8%). According toNT RHDregister 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 definiteRHDor definite or probableARF. Conclusion Passive case finding forARFandRHDis inadequate in some remote Australian communities with a very high burden ofRHD, placing children and young people with undetectedRHDat great risk of poor health outcomes. Active case finding by regular echocardiographic screening is required in such areas.