A Study on Rheumatic Heart Disease Prevalence and Cardiovascular outcomes among Children

Rheumatic heart disease (RHD) remains a major contributor to morbidity and mortality in developing countries. In the present study, cross-sectional survey is designed to determine the prevalence of RHD in children from private and public schools between the age of 5 and 15 years in urban and rural areas of East Godavari District of Andhra Pradesh using both cardiac auscultation and echocardiographic evaluation. This study describes a comprehensive approach to implement echocardiographic screening in a high prevalence region as recommended by the WHO and outlines a robust analysis plan to investigate clinical outcome with secondary prevention for subclinical RHD. Even though the population attributable risk of RHD is expected to be high, false-positive screening results may occur. In order to reduce false-positive findings, all echocardiographic clips with borderline or definite RHD will be assessed from two independent cardiologists. Moreover, screening in a large population of schoolchildren might yield in exceptional cases important incidental clinical findings unrelated to RHD but yet relevant for future prognosis (i.e., bicuspid aortic valve, atrial-septal defect). Prospective clinical studies investigating the impact of secondary prevention for subclinical RHD on long-term clinical outcome will be of central relevance for future health resource utilization in developing countries.