Rheumatic heart disease in Indigenous children in northern Australia: differences in prevalence and the challenges of screening

The research compared regional differences in the prevalence of rheumatic heart disease (RHD) detected by echocardiographic screening in high-risk Indigenous Australian children, and examined the logistical and other practical challenges of RHD screening. Thirty-two remote communities in four regions of northern and central Australia were involved in the study and 3946 Aboriginal or Torres Strait Islander children aged 5 to 15 years participated in the research. Portable echocardiography was performed by cardiac sonographers. Echocardiograms were recorded and reported offsite by a pool of cardiologists and RHD was diagnosed according to 2012 World Heart Federation criteria. The study showed the prevalence of definite RHD differed between regions, from 4.7/1000 in Far North Queensland to 15.0/1000 in the Top End of the Northern Territory. The prevalence of definite RHD was greater in the Top End than in other regions. Fifty-three per cent of detected cases of definite RHD were new cases; the prevalence of new cases of definite RHD was 4.6/1000 for the entire sample and 7.0/1000 in the Top End. Evaluation of socioeconomic data suggests that the Top End group was the most disadvantaged in the study population. In summary, the study identified a previously unrecognised difference in the prevalence of RHD in four remote regions of northern Australia. The prevalence of definite RHD in Top End children was nearly twice as high as that in the other three regions, and this may be related to socioeconomic factors. The researchers estimate that 4 - 8 per 1000 Indigenous children in remote communities have undetected RHD that could be identified by echocardiographic screening. Whether such screening should be recommended will require further and careful consideration of its cost effectiveness, feasibility, sustainability and impact on primary and specialist health care services. The researchers are currently preparing a cost effectiveness analysis that will allow for informed recommendations regarding RHD screening to national policymakers.&nbsp