Rheumatic Heart Disease in Peru: Prevalence and Cardiovascular Outcomes Among Schoolchildren
Condition: Rheumatic Heart Disease; Acute Rheumatic Fever
MeSH terms: Rheumatic Heart Disease; Rheumatic Fever; Rheumatic Diseases; Heart Diseases
Study type: Observational

Summary: 
      Rheumatic heart disease remains a major challenge in low and middle income countries. Early
      detection of clinically silent valvular lesions by screening echocardiography allows timely
      implementation of secondary antibiotic prevention, and may prevent progression of disease to
      severe valvular damage and heart failure. The objective of the study is to assess the
      prevalence of rheumatic heart disease among schoolchildren in Arequipa, Peru. Subsequently,
      the investigators will evaluate progression of disease in children with early stages of
      subclinical rheumatic heart disease.

      The investigators will perform a population-based observational survey for rheumatic heart
      disease using portable echocardiography among schoolchildren aged 5 to 16 years from randomly
      selected public and private schools. Rheumatic heart disease will be documented both
      according to the modified World Health Organization definition and the echocardiographic
      criteria suggested by the World Heart Federation.
    

Detailed description: 
      Background

      Rheumatic fever complicated by rheumatic heart disease continues to be a major contributor to
      morbidity and premature death in low- and middle-income countries where it accounts for up to
      a quarter of a million deaths every year. Rheumatic fever results from an autoimmune response
      to groups A streptococcal pharyngitis and may progress to rheumatic heart disease with
      cumulative exposure. Data on prevalence of rheumatic heart disease in Latin America is scarce
      and ranges from 1.3/1000 as assessed by cardiac auscultation to 4.1/1000 as assessed by
      echocardiography.

      Secondary antibiotic prevention and inclusion of patients with rheumatic heart disease in a
      registry with close follow-up has been demonstrated to reduce the cardiovascular sequelae
      associated with disease progression.

      The natural course of early, clinically silent stages of rheumatic heart disease is largely
      unknown. Disease regression has been reported in up to one third of children with early
      morphological valvular changes consistent with rheumatic heart disease.

      Objective

      The objective of the study is to assess the prevalence of rheumatic heart disease among
      schoolchildren in Arequipa, Peru. Subsequently, the investigators will investigate
      progression of disease in children with early stages of subclinical rheumatic heart disease.

      Methods

      The investigators will perform a population-based observational survey for rheumatic heart
      disease using portable echocardiography among schoolchildren aged 5 to 16 years from randomly
      selected public and private schools. Rheumatic heart disease will be documented both
      according to the modified World Health Organization definition and the echocardiographic
      criteria suggested by the World Heart Federation. Children diagnosed with rheumatic heart
      disease will be started on secondary antibiotic prevention and included into a prospective
      registry with longitudinal follow-up.
    

Intervention name(s): Echocardiography
Intervention type(s): Other
Intervention description(s): Echocardiography examination
Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        Schoolchildren aged 5 to 16 years from Arequipa,Peru. Among 457 schools we randomly
        selected 40 classes from 20 schools using a mutlistage sampling strategy.
      
Keywords: Rheumatic heart disease; Rheumatic fever; Mitral regurgitation; Aortic regurgitation; Mitral stenosis