Pilot Study on Prevalence of Rheumatic Heart Disease in Urban and Rural Angola by Echocardiography-Juniper Publishers


Pilot Study on Prevalence of Rheumatic Heart Disease in Urban and Rural Angola by Echocardiography by Michelle Kwokc in Journal of Cardiology & Cardiovascular Therapy in Juniper Publishers
Rheumatic heart disease is an important cause of death and disability in young people in sub-Saharan Africa. Prevalence of rheumatic heart disease has been studied in many African countries, but no such report for Angola. The objective of this pilot study is to address rheumatic heart disease prevalence in Angola. Echocardiography has been shown to be much more sensitive than clinical detection of rheumatic heart disease. Portable and handheld echo devices were used to screen for prevalence in urban and rural areas. Five sites with no previous rheumatic heart disease screening were chosen and classified according to levels of healthcare access (Table 1). At each site children between ages 4-20 who consented were screened. Two cardiologists performed onsite echo and diagnosed rheumatic heart disease based on 2012 World Heart Federation criteria. Abnormal studies were externally reviewed to confirm the diagnosis. Positive cases were referred to local clinics for follow-up. 574 cases were screened, with 17 positive. Overall prevalence was 29.6 cases per 1000, with a 95% confidence interval between 17.3-47.0. External review concordance rate was 94%. Level 3 areas (lowest healthcare access) had highest prevalence of rheumatic heart disease. (Level 1= 0, Level 2 = 23.0, Level 3 = 71.4, per 1000, p = 0.04). Mitral valve was predominately affected (MV=17, AV=3). Posterior mitral regurgitation was the dominant lesion in early disease (MR = 17, MS =3). Average age of positive cases was 10. Rheumatic heart disease is highly prevalent in Angola, and areas with lower access to healthcare had a higher disease rate. Early disease is mainly manifested through posterior mitral regurgitation. This study demonstrates an urgent need for a bigger study involving broader regions to define true disease burden, as well as public health intervention including early detection and secondary prophylaxis in reducing rheumatic heart disease in resource-limited areas.

https://juniperpublishers.com/jocct/JOCCT.MS.ID.555554.php

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