Menzies School of Health Research, Charles Darwin University, Darwin, NT.
Royal Darwin Hospital, Darwin, NT.
Med J Aust. 2020 Aug;213(3):118-123. doi: 10.5694/mja2.50682. Epub 2020 Jul 6.
Using echocardiographic screening, to estimate the prevalence of rheumatic heart disease (RHD) in a remote Northern Territory town.
Prospective, cross-sectional echocardiographic screening study; results compared with data from the NT rheumatic heart disease register.
SETTING, PARTICIPANTS: People aged 5-20 years living in Maningrida, West Arnhem Land (population, 2610, including 2366 Indigenous Australians), March 2018 and November 2018.
Echocardiographic screening for RHD by an expert cardiologist or cardiac sonographer.
Definite or borderline RHD, based on World Heart Federation criteria; history of acute rheumatic fever (ARF), based on Australian guidelines for diagnosing ARF.
The screening participation rate was 72%. The median age of the 613 participants was 11 years (interquartile range, 8-14 years); 298 (49%) were girls or women, and 592 (97%) were Aboriginal Australians. Definite RHD was detected in 32 screened participants (5.2%), including 20 not previously diagnosed with RHD; in five new cases, RHD was classified as severe, and three of the participants involved required cardiac surgery. Borderline RHD was diagnosed in 17 participants (2.8%). According to NT RHD register data at the end of the study period, 88 of 849 people in Maningrida and the surrounding homelands aged 5-20 years (10%) were receiving secondary prophylaxis following diagnoses of definite RHD or definite or probable ARF.
Passive case finding for ARF and RHD is inadequate in some remote Australian communities with a very high burden of RHD, placing children and young people with undetected RHD at great risk of poor health outcomes. Active case finding by regular echocardiographic screening is required in such areas.
通过超声心动图筛查，估计北领地偏远城镇风湿性心脏病（RHD）的患病率。
前瞻性、横断面超声心动图筛查研究；结果与北领地风湿性心脏病登记处的数据进行比较。
地点、参与者：2018 年 3 月至 11 月，生活在西阿伦特兰曼宁格里达（人口 2610 人，包括 2366 名澳大利亚原住民）的 5-20 岁人群。
由专家心脏病专家或心脏超声医师进行 RHD 超声心动图筛查。
根据世界心脏联合会标准确定的明确或临界 RHD；根据澳大利亚诊断急性风湿热（ARF）的指南确定的 ARF 病史。
筛查参与率为 72%。613 名参与者的中位年龄为 11 岁（四分位间距 8-14 岁）；298 名（49%）为女孩或女性，592 名（97%）为澳大利亚原住民。在 32 名接受筛查的参与者中发现了明确的 RHD，其中 20 名之前未被诊断患有 RHD；在 5 例新病例中，RHD 被归类为严重，其中 3 例涉及需要心脏手术。在 17 名参与者中诊断出临界 RHD。根据研究期末北领地 RHD 登记处的数据，在曼宁格里达及其周边家园的 849 名 5-20 岁人群中，有 88 人（10%）在确诊 RHD 或明确或可能的 ARF 后接受二级预防。
在 RHD 负担极高的一些偏远澳大利亚社区，被动发现 ARF 和 RHD 是不够的，这使未被发现的 RHD 儿童和年轻人面临不良健康后果的巨大风险。在这些地区需要定期进行超声心动图筛查以主动发现病例。
