Saving time saves lives! A time focused evaluation of a single-view echocardiographic screening protocol for subclinical rheumatic heart disease

Johannsen, Ronald A.; Kaltenborn, Zachary P.; Shroff, Gautam R.

doi:10.1016/j.ijcard.2021.12.031

Cited by 3 publications

(5 citation statements)

References 20 publications

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“…Such a quick assessment can be considered in large screening programs with the limited availability of expert cardiologists. Screening a large number of children in an endemic region means early diagnosis, which in turn can save more children from morbidity and premature mortality 60 .…”

Section: Findings and Discussionmentioning

confidence: 99%

Detection and management of latent rheumatic heart disease: a narrative review

Lamichhane,

Patel,

Al Mefleh

et al. 2023

Annals of Medicine &Amp; Surgery

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Rheumatic heart disease (RHD) is a public health concern in many developing nations around the world. Early detection of latent or subclinical RHD can help in reversing mild lesions, retarding disease progression, reducing morbidity and mortality, and improving the quality of life of patients. Echocardiography is the gold-standard method for screening and confirming latent RHD cases. The rates and determinants of progression of latent RHD cases as assessed by echocardiography have been found to be variable through studies. Even though latent RHD has a slow rate of progression, the rate of progression of its subtype, ʻdefiniteʼ RHD, is substantial. A brief training of nonexpert operators on the use of handheld echocardiography with a simplified protocol is an important strategy to scale up the screening program to detect latent cases. Newer advancements in screening, such as deep-learning digital stethoscopes and telehealth services, have provided an opportunity to expand screening programs even in resource-constrained settings. Newer studies have established the efficacy and safety profile of secondary antibiotic prophylaxis in latent RHD. The concerned authorities in endemic regions of the world should work on improving the availability and accessibility of antibiotic prophylaxis.

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Section: Findings and Discussionmentioning

confidence: 99%

Detection and management of latent rheumatic heart disease: a narrative review

Lamichhane,

Patel,

Al Mefleh

et al. 2023

Annals of Medicine &Amp; Surgery

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“…In April of 2019, Soddo Christian Hospital began operating a RHD screening program following our previously described protocol 23 . The screening team consists of six locally trained RHD screeners under the supervision of an onsite physician.…”

Section: Methodsmentioning

confidence: 99%

“…Where appropriate, separate images were saved for the aortic and mitral valves. Our study intervention did not alter the recommendations of the screening team and all children determined to be positive by the screening team were referred per protocol for confirmatory echocardiogram using a modified WHF criteria as the gold standard as described previously 23 . This study was reviewed and approved by the Institutional Review Boards of Soddo Christian Hospital and the University of Minnesota.…”

Section: Methodsmentioning

confidence: 99%

“…If the regurgitation was eccentric, an estimated length of more than 1 cm was considered positive; (2) Any regurgitation at the aortic valve; (3) Any valvular abnormalities consistent with RHD. These criteria were derived from the findings of published studies and expert consensus 10 , 20 , 21 , 23 , 24 . Two study investigators reviewed all ultrasounds, one an experienced cardiologist (R.J., expert) and the other an internal medicine and pediatric hospitalist (Z.K., non-expert) with experience in the use of point of care ultrasound.…”

Section: Methodsmentioning

confidence: 99%

“…Through focused training, non-physician ultrasonographers using simplified screening protocols can achieve sensitivities and specificities for detecting early RHD ranging between 74-84% and 78-90% respectively 16 , 17 , 18 , 19 . Studies evaluating single image protocols with color Doppler of the mitral and aortic valves have demonstrated sensitivity of 73-92% and specificity of 75-100% for latent RHD and screening times of 1-4 minutes 20 , 21 , 22 , 23 . More recently, an augmented single-view screening protocol was prospectively evaluated in a cohort of school-children in Timor-Leste and demonstrated a sensitivity of 100% and a specificity of 95% when completed by an expert cardiologist using standard echocardiography equipment 24 .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Impact of a Handheld Ultrasound Device in a Rheumatic Heart Disease Screening Program in Ethiopia

Kaltenborn,

Zewde,

Kirsch

et al. 2023

pocus

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Background: Rheumatic heart disease affects 33 million people in low and middle income countries and is the leading cause of cardiovascular death among children and young adults. Penicillin prophylaxis prevents progression in asymptomatic disease. Efforts to expand echocardiographic screening are focusing on simplified protocols, non-physician ultrasonographers, and portable ultrasound devices, including handheld ultrasound. Recent advances support the use of single-view screening protocols. With the increasing availability and low cost of handheld devices, studies are needed to evaluate their performance in these settings. Methods: We conducted a retrospective study comparing the rate of screen positive ultrasounds before and after the use of a handheld ultrasound in an RHD screening program in Ethiopia. We also performed a cross-sectional device comparison in 19 at-risk school-children participating in the rheumatic heart disease screening program. Results: Between March of 2019 and Jan of 2022, 6631 children were screened for rheumatic heart disease of whom 4029 were screened after the introduction of a handheld device. Before the use of the handheld ultrasound device 291 (11.2%) children had a screen positive ultrasounds compared with 167 (4.1%) afterwards (p < 0.001). We also compared non-expert to expert interpretation by device and found a significant difference in interpretation for the Lumify (p=0.025). There was a trend towards shorter jet length by color Doppler in the handheld ultrasound device for both expert and non-expert review. Conclusions: Our study highlights that the screen-positive rate in a RHD screening program is influenced by the device being used in the screening process.

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Screening for Rheumatic Heart Disease in the Community: Can non-experts do the task?

Narayanan¹,

Marijon

2023

International Journal of Cardiology

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Saving time saves lives! A time focused evaluation of a single-view echocardiographic screening protocol for subclinical rheumatic heart disease

Cited by 3 publications

References 20 publications

Detection and management of latent rheumatic heart disease: a narrative review

Detection and management of latent rheumatic heart disease: a narrative review

The Impact of a Handheld Ultrasound Device in a Rheumatic Heart Disease Screening Program in Ethiopia

Screening for Rheumatic Heart Disease in the Community: Can non-experts do the task?

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