Abstract: Introduction: Globally, most patients with rheumatic heart disease (RHD) do not have a history of acute rheumatic fever (ARF). The Indigenous people of the Northern Territory (NT) of Australia have some of the highest rates of ARF and RHD in the world. Coordinated register-based delivery of secondary prophylaxis has been active for two decades. This study aimed to better define the burden of RHD using active case finding for RHD in school-aged children in a remote community in the NT. Methods: A community-driven approach to engagement and education on ARF/RHD was implemented on the invitation of the Maningrida community. For active case finding, participants aged 5–20y had echocardiography performed by cardiologists. Diagnoses of RHD were made according to World Heart Federation criteria. Echo data were combined with register data to describe the burden of ARF/RHD. Results: Estimated target population (aged 5–20y) was 849 people. Of these, 615 (72.4%) underwent echocardiography (median age 11y). An existing diagnosis of probable/definite ARF and/or RHD was recorded in 44/615 (7.2%). At screening, 13 known cases and 19 new cases were found to have definite RHD (32/615, 5.2%); 6/615 (1.0%) have had cardiac surgery for severe RHD, including 3 new cases. Conclusion: The burden of ARF/RHD in Maningrida is extremely high. Active case finding using echocardiography facilitates detection and access to treatment, even in settings with effective primary health care and ongoing disease surveillance. Community engagement and education are key to early detection and treatment, as well as primordial and primary prevention of ARF/RHD.
Francis, Joshua, Fairhurst, Helen, Hardefeldt, Hilary, Ryan, Chelsea, Ryan, Shannon, Smith, Greg, Horton, Ari, Whalley, Gillian, Kaethner, Alex, Marangou, James, James, Christian, Draper, Anthony, Mitchell, Alice, Yan, Jennifer, Ralph, Anna, Remenyi, Bo, 2019, Echocardiographic screening detects extremely high prevalence of RHD in Australia, Volume:28, Journal Article, viewed 18 August 2022, https://www.nintione.com.au/?p=15228.