Abstract 4365065: Prevalence of Latent Rheumatic Heart Disease in Brazilian Public Schools: Results 10 Years After Implementation of a Screening Program

Abstract

Introduction: Echocardiographic (echo) screening has emerged as an useful tool for identifying latent Rheumatic Heart Disease (RHD), surpassing clinical exam in accuracy. Diagnostic criteria for echo-detected RHD were standardized by the World Heart Federation (WHF) in 2012 and revised in 2023. Screening programs have been implemented across Minas Gerais, Southeast Brazil since 2014. We aimed to assess the prevalence of latent RHD in children and adolescents (ages 5–18) and to compare findings to earlier screening phases prior to program rollout. Methods: The PROVAR+ program utilizes telemedicine and handheld ultrasound devices (Philips Lumify®) for school-based RHD screening in low-income areas of Minas Gerais. Studies are remotely interpreted by cardiologists in Brazil and the US by telemedicine, using WHF 2012/2023 criteria via a cloud-based platform (Tricefy, USA). We report 24-month screening data from public schools selected by priority criteria of the local board of education. Risk factors were analyzed, and prevalence was compared to results from an earlier cohort screened between 2014–2017 in socio-demographically similar regions (close neighborhoods, with superimposable Human Development Indexes). Results: A total of 1,072 students from 8 public schools were screened. Mean age was 14.4±3.7 years; 62% were female. Overall RHD prevalence was 2.5% (95% CI 1.7–3.6), with 2.1% borderline RHD (n=23) and 0.4% definite RHD (n=4). Among borderline cases, 74% (n=17) had isolated mitral regurgitation, 17% (n=4) isolated aortic regurgitation, and 9% (n=2) had ≥2 morphological RHD findings in mitral or aortic valves. Minor congenital heart disease was observed in 18 children (1.7%). Compared to baseline data from 2014–2017 (4.5% (95% CI 4.2 – 4.9) prevalence among 12,056 schoolchildren screened), the current prevalence was significantly lower (p=0.002). Prevalence was similar by sex (female: 2.7% vs. male: 2.2%, p=0.69) and by age (<14 vs. ≥14 years: 1.6% vs. 3.2%, p=0.12). Household crowding (number of residents) did not differ between those with and without RHD (4.1±1.3 vs. 3.7±1.1, p=0.07). Conclusions: The prevalence of latent RHD among Brazilian children remains significantly high, but a reduction was observed 10 years after the implementation of health education and screening initiatives, presumably due to the combined impact of these locally applied strategies. These findings are important for informing public health policies aimed at addressing RHD.