Rheumatic heart disease in Indigenous children in northern Australia: differences in prevalence and the challenges of screening
Indigenous Australians (Aboriginal Australians and/or Torres Strait Islander peoples) suffer high rates of acute rheumatic fever (ARF) and its sequel, rheumatic heart disease (RHD).1,2 Estimates of RHD prevalence have relied on register data collected for clinical purposes or on intermittent enhanced surveillance projects,3 and have suggested that 1%–2% of Indigenous Australians living in northern and central Australia have RHD.
Screening for RHD provides an opportunity to accurately define the current disease burden, as well as to identify children with undiagnosed disease who may benefit from early treatment. A number of studies have shown that cardiac auscultation lacks the sensitivity and specificity required for screening for RHD and should no longer be used for this purpose.4–6 Portable echocardiography has emerged as a more valuable tool, and its usefulness was enhanced by the publication of the World Heart Federation (WHF) criteria for the echocardiographic diagnosis of RHD in 2012 (Box 1).7
We recently published the results of an echocardiographic screening study of more than 5000 school-aged children, including nearly 4000 Indigenous children living in four regions of northern and central…