Echocardiographic prevalence of rheumatic heart disease in Brazilian schoolchildren: Data from the PROVAR study

BackgroundAccurate estimates of Rheumatic Heart Disease (RHD) burden are needed to justify improved integration of RHD prevention and screening into the public health systems, but data from Latin America are still sparse.ObjectiveTo determine the prevalence of RHD among socioeconomically disadvantaged youth (5-18 years) in Brazil and examine risk factors for the disease.MethodsThe PROVAR program utilizes non-expert screeners, telemedicine, and handheld and standard portable echocardiography to conduct echocardiographic screening in socioeconomically disadvantaged schools in Minas Gerais, Brazil. Cardiologists in the US and Brazil provide expert interpretation according to the 2012 World Heart Federation Guidelines. Here we report prevalence data from the first 14 months of screening, and examine risk factors for RHD.Results5996 students were screened across 21 schools. Median age was 11.9 [9.0/15.0] years, 59% females. RHD prevalence was 42/1000 (n = 251): 37/1000 borderline (n = 221) and 5/1000 definite (n = 30). Pathologic mitral regurgitation was observed in 203 (80.9%), pathologic aortic regurgitation in 38 (15.1%), and mixed mitral/aortic valve disease in 10 (4.0%) children. Older children had higher prevalence (50/1000 vs. 28/1000, p < 0.001), but no difference was observed between northern (lower resourced) and central areas (34/1000 vs. 44/1000, p = 0.31). Females had higher prevalence (48/1000 vs. 35/1000, p = 0.016). Age (OR = 1.15, 95% CI:1.10-1.21, p < 0.001) was the only variable independently associated with RHD findings.ConclusionsRHD continues to be an important and under recognized condition among socioeconomically disadvantaged Brazilian schoolchildren. Our data adds to the compelling case for renewed investment in RHD prevention and early detection in Latin America.