title: Echocardiographic screening for rheumatic heart disease in high and low risk Australian children.
abstract: BACKGROUND
  Echocardiographic screening for rheumatic heart disease (RHD) is becoming more widespread, but screening studies to date have used different echocardiographic definitions. The World Heart Federation has recently published new criteria for the echocardiographic diagnosis of RHD. We aimed to establish the prevalence of RHD in high-risk Indigenous Australian children using these criteria and to compare the findings with a group of Australian children at low risk for RHD.
  
  
  RESULTS
  Portable echocardiography was performed on high-risk Indigenous children aged 5 to 15 years living in remote communities of northern Australia. A comparison group of low-risk, non-Indigenous children living in urban centers was also screened. Echocardiograms were reported in a standardized, blinded fashion. Of 3946 high-risk children, 34 met World Heart Federation criteria for definite RHD (prevalence, 8.6 per 1000 [95% confidence interval, 6.0-12.0]) and 66 for borderline RHD (prevalence, 16.7 per 1000 [95% confidence interval, 13.0-21.2]). Of 1053 low-risk children, none met the criteria for definite RHD, and 5 met the criteria for borderline RHD. High-risk children were more likely to have definite or borderline RHD than low-risk children (adjusted odds ratio, 5.7 [95% confidence interval, 2.3-14.1]; P<0.001).
  
  
  CONCLUSIONS
  The prevalence of definite RHD in high-risk Indigenous Australian children approximates what we expected in our population, and no definite RHD was identified in the low-risk group. This study suggests that definite RHD, as defined by the World Heart Federation criteria, is likely to represent true disease. Borderline RHD was identified in children at both low and high risk, highlighting the need for longitudinal studies to evaluate the clinical significance of this finding.
authors.affiliation: Menzies School of Health Research, Darwin, Northern Territory, Australia (K.R., B.R., J.-Y.S., J.R.C.); Department of Paediatrics (K.R.) and Northern Territory Cardiac Services (B.R.), Royal Darwin Hospital, Darwin, Northern Territory, Australia; Baker IDI Central Australia, Alice Springs, Northern Territory, Australia (G.M., A.B.); Cairns Clinical School, School of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia (G.M.); South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia (A.B.); School of Population Health, University of South Australia, Adelaide, Australia (A.B.); Rural Clinical School of Western Australia, University of Western Australia, Broome, Western Australia, Australia (D.A.); Kimberley Aboriginal Medical Services Council, Broome, Western Australia, Australia (D.A.); Department of Cardiology, Women's and Children's Hospital, Adelaide, South Australia, Australia (G.W., A.K.); Flinders University, Adelaide, South Australia, Australia (G.W.); Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India (R.K.K.); Centre for Disease Control, Department of Health, Darwin, Northern Territory, Australia (J.-Y.S.); Telethon Kids Institute, University of Western Australia, Perth, Australia (J.R.C.).
authors.forename: Kathryn
authors.initials: K
authors.lastname: Roberts
authors.forename: Graeme
authors.initials: G
authors.lastname: Maguire
authors.forename: Alex
authors.initials: A
authors.lastname: Brown
authors.forename: David
authors.initials: D
authors.lastname: Atkinson
authors.forename: Bo
authors.initials: B
authors.lastname: Reményi
authors.forename: Gavin
authors.initials: G
authors.lastname: Wheaton
authors.forename: Andrew
authors.initials: A
authors.lastname: Kelly
authors.forename: Raman K
authors.initials: RK
authors.lastname: Kumar
authors.forename: Jiunn-Yih
authors.initials: JY
authors.lastname: Su
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Carapetis
mesh_terms: D000293:Adolescent; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D015588:Observer Variation; D044382:Population Groups; D015995:Prevalence; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D012307:Risk Factors
keywords: echocardiography; mass screening; pediatrics; rheumatic heart disease