Rheumatic Heart Disease Clinical Trial
Official title:
Rheumatic Heart Disease in Peru: Prevalence and Cardiovascular Outcomes Among Schoolchildren
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.
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.
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Observational Model: Cohort, Time Perspective: Cross-Sectional
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