title: Clinical outcomes for young people with screening-detected and clinically-diagnosed rheumatic heart disease in Fiji.
abstract: BACKGROUND
  Echocardiographic screening is under consideration as a disease control strategy for rheumatic heart disease (RHD). However, clinical outcomes of young people with screening-detected RHD are unknown. We aimed to describe the outcomes for a cohort with screening-detected RHD, in comparison to patients with clinically-diagnosed RHD.
  
  
  METHODS
  A retrospective cohort study included all young people with screening-detected RHD in the Central Division of Fiji in the primary cohort. Screen-negative and clinically-diagnosed comparison groups were matched 1:1 to the primary cohort. Data were collected on mortality, clinical complications and healthcare utilisation from the electronic and paper health records and existing databases.
  
  
  RESULTS
  Seventy participants were included in each group. Demographic characteristics of the groups were similar (median age 11years, 69% female, median follow-up 7years). There were nine (12.9%) RHD-related deaths in the clinically-diagnosed group and one (1.4%) in the screening-detected group (Incident Rate Ratio: 9.6, 95% CI 1.3-420.6). Complications of RHD were observed in 39 (55.7%) clinically-diagnosed cases, four (20%) screening-detected cases and one (1.4%) screen-negative case. There were significant differences in the cumulative complication curves of the groups (p<0.001). Rates of admission and surgery were highest in the clinically-diagnosed group, and higher in the screening-detected than screen-negative group.
  
  
  CONCLUSIONS
  Young people with screening-detected RHD have worse health outcomes than screen-negative cases in Fiji. The prognosis of clinically-diagnosed RHD remains poor, with very high mortality and complication rates. Further studies in other settings will inform RHD screening policy. Comprehensive control strategies are required for disease prevention.
authors.affiliation: Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Royal Children's Hospital, Melbourne, Victoria, Australia. Electronic address: Daniel.Engelman@rch.org.au.
authors.forename: Daniel
authors.initials: D
authors.lastname: Engelman
authors.affiliation: Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji.
authors.forename: Reapi L
authors.initials: RL
authors.lastname: Mataika
authors.affiliation: Fiji Rheumatic Heart Disease Control Program, Suva, Fiji.
authors.forename: Maureen
authors.initials: M
authors.lastname: Ah Kee
authors.affiliation: Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Donath
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Tom
authors.initials: T
authors.lastname: Parks
authors.affiliation: Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
authors.forename: Samantha M
authors.initials: SM
authors.lastname: Colquhoun
authors.affiliation: Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; Perth Children's Hospital, Perth, Western Australia, Australia.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Carapetis
authors.affiliation: Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji; Fiji Rheumatic Heart Disease Control Program, Suva, Fiji; College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Kado
authors.affiliation: Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Steer
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D005260:Female; D005367:Fiji / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult
keywords: Complications; Echocardiography; Mass screening; Morbidity; Mortality; Rheumatic heart disease; Survival analysis