Echocardiographic Screening for Rheumatic Heart Disease

Rheumatic fever (RF) continues to be a major health challenge in developing countries, where it is the most common cause of acquired cardiac disease in children and young adults. Worldwide, it is estimated that at least 470 000 cases of RF occur annually, with the majority occurring in children 5 to 14 years of age.1 The majority of cases occur in developing countries and in indigenous populations, where the reported incidence is as high as 200 to 300 per 100 000.1–3 Because of the difficulty in obtaining data in these regions and populations, it is possible that the true incidence in some areas is even higher; community-based surveillance suggests that the true incidence in some settings may be as high as 500 per 100 000.4,5 In sharp contrast, there has been a significant decline in the incidence of RF over the last 50 years in most developed countries of the world. The initial decline began at least partly as a result of improved socioeconomic conditions, with further acceleration in the rate of decline of RF seen after the initiation of penicillin.6 The prevalence of rheumatic heart disease (RHD) parallels the reported incidences of RF. Both RF and RHD continue essentially unabated in many developing countries and in indigenous populations (such as that in Australia); in these settings, RHD remains an important and significant cause of morbidity and mortality. Worldwide, it is estimated that 15 to 20 million people have RHD.1,7 Given the current estimates of RF incidence and the proportion of patients who develop RHD, it is estimated that at least 282 000 people develop RHD each year.1 Compared with cases occurring in industrialized countries, the initial episode of RF in …