Echocardiography Screening for Latent Rheumatic Heart Disease: What Can We Do in Indonesia?

Abstract

Rheumatic heart disease (RHD), a sequela of acute rheumatic fever (ARF), is a preventable disease but remains a significant health problem, especially in developing countries. It causes disability, poor quality of life, early mortality, and national economic burden. The World Heart Federation (WHF) aimed to achieve a 25% reduction in premature deaths from ARF and RHD among individuals aged <25 years by 2025. Primordial and primary prophylaxis of RHD is aimed to prevent the occurrence of ARF, while the goal of secondary and tertiary prophylaxis is to limit the progression and reduce the consequences of RHD. Early recognition of RHD is important for early prophylaxis strategies to inhibit any progression to advanced stages. In 2012, WHF introduced the latest echocardiographic criteria to recognize the early stage of RHD. This includes the evaluation of pathological regurgitation jet and morphological features of RHD based on 2D, color, and spectral Doppler criteria. In remote areas, portable echocardiography is preferable for RHD screening. Previous portable devices were only capable of producing 2D and color images. Hence, a simplified echocardiographic criterion without spectral Doppler evaluation is needed in selected areas. Indonesia is a developing country, an archipelago with a population of over 250 million. Currently, there are no data on ARF incidence and RHD prevalence nationwide. The only data available are the number of patients in advanced stages who came to referral centers for further management. The screening program has to be introduced in Indonesia as part of national RHD prophylaxis.

Isolated rheumatic tricuspid valve regurgitation: it is only rare not just a myth: rare case report

“…The patient received a diagnosis of IRTR due to latent RHD based on heart failure as the worsening complication of RHD and an echocardiographic finding with an undocumented history of ARF [ 7 ].…”

Clinical Cardiology in South East Asia: Indonesian Lessons from the Present towards Improvement

“…Since rheumatic fever is mostly experienced by school-aged children, screening in school to discover those in need of secondary prophylaxis might be the most appropriate within a limited resource country. Along with it, training specialization on echocardiography for diagnostic of RHD amongst cardiologists, general physicians, and nurses could probably help reach the rural area [ 51 ]. Currently, Jones criteria for rheumatic fever diagnosis are less sufficient to diagnose recurrent rheumatic fever [ 24 ], thus adapted clinical pathway according to data from local studies needs to be developed.…”

Echocardiography Screening for Diagnosis of Latent RHD Using Nurses: Is the Project Feasible for Nepal?

“…The following factors will need to be determined for an expanded latent RHD detecting echo screening system: feasibility of training the non-experts, the target audience, devices that can be used in rural settings, assessment of adequate training, and use of simplified echo criteria for diagnosis of latent RHD 3 . a) Feasibility and assessment of training with simplified criteria in non-experts (e.g.…”

“…However, RHD remains a leading public health problem in developing countries, with devastating effects on children and young adults in their most productive years of life 2 . The 21st century has shown a lack of research in the area of RHD in developing countries, due to which effective policies to combat RHD have been stalling 1,3,4 .…”