Comparison Between Different Strategies of Rheumatic Heart Disease Echocardiographic Screening in Brazil: Data From the PROVAR (Rheumatic Valve Disease Screening Program) Study

Autor: Bruno R. Nascimento, Craig Sable, Maria Carmo P. Nunes, Adriana C. Diamantino, Kaciane K. B. Oliveira, Cassio M. Oliveira, Zilda Maria A. Meira, Sandra Regina T. Castilho, Júlia P. A. Santos, Letícia Maria M. Rabelo, Karlla C. A. Lauriano, Gabriel A. L. Carmo, Allison Tompsett, Antonio Luiz P. Ribeiro, Andrea Z. Beaton, Amanda O. Lauar, Ana Luísa M. Costa, Camila G. Ferreira, Catherine L. Webb, Eduardo L. V. Lopes, Gabriela Z. L. Ruiz, Graziela Chequer, Hedda Richards, Iara M. Castro, Isabella M. Teixeira, Lindsay Perlman, Luciana C. X. Lafeta, Luise Cristina T. R. Barros, Michelle C. Galbas, Tainá V. Lourenço, Vitória M. L. R. de Rezende
Rok vydání: 2018
Předmět:
Male
Comparative Effectiveness Research
medicine.medical_specialty
Telemedicine
Adolescent
Heart disease
prevalence
Heart Valve Diseases
Physical examination
030204 cardiovascular system & hematology
03 medical and health sciences
Age Distribution
0302 clinical medicine
Predictive Value of Tests
Informed consent
Pediatric Cardiology
Epidemiology
medicine
Humans
Mass Screening
echocardiography
030212 general & internal medicine
Child
School Health Services
Original Research
Public Sector
Quality and Outcomes
Primary Health Care
medicine.diagnostic_test
business.industry
screening
Rheumatic Heart Disease
Odds ratio
Health Services
medicine.disease
Confidence interval
Valvular Heart Disease
Family medicine
Female
Private Sector
telemedicine
Cardiology and Cardiovascular Medicine
business
Brazil
Valve disease
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
DOI: 10.1161/jaha.117.008039
Popis: Background Considering the limited accuracy of clinical examination for early diagnosis of rheumatic heart disease ( RHD ), echocardiography has emerged as an important epidemiological tool. The ideal setting for screening is yet to be defined. We aimed to evaluate the prevalence and pattern of latent RHD in schoolchildren (aged 5–18 years) and to compare effectiveness of screening between public schools, private schools, and primary care centers in Minas Gerais, Brazil. Methods and Results The PROVAR (Rheumatic Valve Disease Screening Program) study uses nonexperts and portable and handheld devices for RHD echocardiographic screening, with remote interpretation by telemedicine, according to the 2012 World Heart Federation criteria. Compliance with study consent and prevalence were compared between different screening settings, and variables associated with RHD were analyzed. In 26 months, 12 048 students were screened in 52 public schools (n=10 901), 2 private schools (n=589), and 3 primary care centers (n=558). Median age was 12.9 years, and 55.4% were girls. Overall RHD prevalence was 4.0% borderline (n=486) and 0.5% definite (n=63), with statistically similar rates between public schools (4.6%), private schools (3.5%), and primary care centers (4.8%) ( P =0.24). The percentage of informed consents signed was higher in primary care centers (84.4%) and private schools (66.9%) compared with public schools (38.7%) ( P P P =0.02). Only age (odds ratio, 1.12; 95% confidence interval, 1.09–1.17; P RHD . Conclusions RHD screening in primary care centers seems to achieve higher coverage rates. Prevalence among schoolchildren is significantly high, with rates higher than expected in private schools of high‐income areas. These data are important for the formulation of public policies to confront RHD .
Databáze: OpenAIRE
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