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RHD Echo Interactive Session at WCC

25 June 2016
Dr Andrea Beaton presents ‘Short and Sweet – Echo Screening Protocols for RHD’

An interactive session on echocardiographic screening for rheumatic heart disease was held on 6th June at the World Congress of Cardiology and Cardiovascular Health, in Mexico City. 

Chaired by Dr Bo Remenyi – Menzies School of Health Research, Darwin – the session examined the role of screening for RHD, with attendees given the chance to vote on their interpretation of echocardiograms, with expert panelists providing a clinical response.

In her opening comments, Dr. Remenyi provided an overview of RHD and the importance of screening, noting that patients often present too late with advanced rheumatic heart disease. 

Her introduced was followed by a presentation entitled ‘Short and Sweet – Echo Screening Protocols for RHD’ by Dr. Andrea Beaton, paediatric cardiologist at the Children’s National Medical Center in Washington D.C, in which she compared and contrasted the characteristics of diagnosis of rheumatic heart disease vs. the screening of RHD. 

She noted that diagnosis was focused on case confirmation and provided sensitivity and specificity, whereas the role of screening was to find RHD cases and provided reasonable, but not total specificity. Furthermore while the diagnosis of RHD should be conducted by experts and is restricted to limited numbers of patients, RHD screening targets larger numbers of the population and can be carried out by non-experts. 

She concluded her presentation by stating that the choice between echo screening by experts in clinical settings and by non-experts in the field was likely to be context-specific, and that there was always a trade-off between sensitivity and specificity, and the number of patients reached.

Dr. Dan Engelman – University of Melbourne – also addressed this topic in a presentation entitled ‘Echo screening for RHD by non-expert operators’. He stressed that in almost all settings where RHD is prevalent, using experts to screen for RHD at the population-level is not feasible. He added that non-experts could be trained to screen for RHD, and that this screening is accurate, citing studies in Fiji, Uganda and Brazil as settings where such RHD screening programmes had been successful. 

However he noted that such programmes did require ongoing training and support, suggesting that a ‘3-step’ approach could be most effective, with a team of three nurses or non-physician health workers led by one more specialized operator. 

Addressing the types of people who should be screened for RHD, Dr. Mariana Mirabel, cardiologist at Hôpital Européen Georges Pompidou, invited the audience to consider whether the RHD community should ‘go beyond school children’, and target young women and those living in overcrowded conditions such as slums and refugee camps. 

Noting that RHD mainly affects young women, Dr. Mirabel drew attention to maternal RHD-related mortality. However she also noted the limitations to RHD screening in pregnancy, stating that in many settings access to birth control and family planning services were lacking, concluding that current data was insufficient to fully support screening additional populations. 

Dr Liesl Zühlke’s presentation examined the long-term findings of RHD detected by echo screening, and the implications of these findings. She noted that there had been very few long-term studies, but that if RHD health workers follow up with patients long enough, they may well find more cases that progress. 

In her summary, Dr Zühlke – paediatric cardiologist and co-director of RhEACH – noted that echo findings revert to normal in almost half cases followed up over the course of 5 years, and that this was particularly the case in people living with RHD. However she also highlighted that critical questions remained, including ethical considerations such as whether any long-term screening studies should be conducted if a reliable supply of BPG could not be assured.

As the final part of the session, facilitator Professor Graeme McGuire then took the audience through a series of echocardiograms. They were given the opportunity to vote on what the distinctive feature was (clinical context and diagnosis) of the echocardiogram, and what action they would take – before hearing how the panel would manage the treatment of the patient. 

You can read more on the topic of echocardiographic screening on the RHD Action website.