Challenges for the Implementation of the First Large-Scale Rheumatic Heart Disease Screening Program in Brazil: The PROVAR Study Experience
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Universidade Federal de Minas Gerais
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Artigo de periódico
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Resumo
Rheumatic Heart Disease (RHD) is the cardiac consequence of acute rheumatic fever (ARF), an inflammatory disease triggered by streptococcal pharyngitis. Although the prevalence of RHD has decreased in high-income countries, lack of social and economic development and poor primary prevention – mainly in in low- and middle-income countries – perpetuate an environment where RHD remains endemic. It is estimated that RHD continues to affect nearly 33 million people worldwide.1 According to the World Health Organization (WHO), RHD is responsible for 1-1.5% of all cardiovascular deaths and 3-4% of cardiovascular Disability-Adjusted Life
Years (DALYs).2 In Brazil, according to the Unified Health System (SUS), there were 26,054 hospital admissions for ARF (45% with cardiac compromise) between 2008 and 2015, and the total cost to SUS was US$3.5 million, a number that is most likely underestimated.3 The main burden of RHD to public health systems consists of repeated hospital admissions and cardiac surgeries in the following decades after initial cardiac damage. If RHD is detected in its early stages, secondary prophylaxis (regular
penicillin injections) can be initiated to prevent new episodes of ARF, avoiding further valve damage and progression of RHD. In high prevalence regions, RHD meets the traditional screening criteria defined by Wilson and Jungner,4 although the long-term clinical significance of latent RHD is not entirely clear. Previous studies have demonstrated, however, that in 38 to 68% of asymptomatic RHD patients, echocardiographic findings show that abnormalities persist, and progress in 4 to 16%,5 reinforcing the importance of
early diagnosis in susceptible populations.The PROVAR study (Programa de Rastreamento da Valvopatia Reumática – Rheumatic Heart Disease Screening Program) is the first large-scale echocardiographic screening program in Brazil, using echocardiography to estimate the prevalence of latent RHD in asymptomatic children between 5 and 18 years old attending public schools of
underserved areas of the cities Belo Horizonte, Montes Claros and Bocaiúva, in the Brazilian State of Minas Gerais. Minas Gerais is the second most populous Brazilian state (>20 million inhabitants) and has a large territory, great geographical diversity and is marked by economic discrepancies between its different regions. This project is a clinical and research collaboration between the University
Hospital of Universidade Federal de Minas Gerais (UFMG), Brazil, and the Children’s National Health System (CNHS)
in Washington DC, United States of America (USA).
Abstract
Assunto
Cardiopatia Reumática, Programas de Rastreamento, Echocardiography, Saúde da criança, Saúde do Adolescente
Palavras-chave
Rheumatic Heart Disease, Mass Screening, Echocardiography, Child Health, Adolescent Health
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https://www.scielo.br/j/abc/a/yzqNHCsknnhVT4wjjsKMKsv/?lang=en