Poster Presentation 20th Lancefield International Symposium on Streptococci and Streptococcal Diseases 2017

The natural history of screening-detected rheumatic heart disease: clinical and echocardiographic outcomes in Fiji (#221)

Daniel Engelman 1 , Reapi L Mataika 2 , Gavin R Wheaton 3 , Maureen Ah Kee 4 , Samantha M Colquhoun 1 , Bo Remenyi 5 , Jonathan R Carapetis 6 , Andrew C Steer 1
  1. Murdoch Childrens Research Institute, Melbourne, Australia
  2. Paediatrics, Colonial War Memorial Hospital, Suva, Fiji
  3. Cardiology, Women's and Children's Hospital, Adelaide, Australia
  4. RHD Control Program, Fiji Ministry of Health and Medical Services, Suva, Fiji
  5. Menzies School of Health Research, Darwin, Australia
  6. Telethon Kids Institute, Perth, Australia


Policy for rheumatic heart disease (RHD) screening is limited by the paucity of data on outcomes after screening. We aimed to compare the clinical outcomes and echocardiographic progression for young people with screening­-detected RHD to a screen-negative population and those with clinically-diagnosed RHD.


This was a cohort study in Fiji, with a primary cohort of 70 young people with screening­-detected, definite RHD. Screen-­negative and clinically­-diagnosed comparison groups were matched 1:1 for demographic characteristics. Retrospective data were collected on clinical outcomes and healthcare episodes. Screening-detected participants with any reported RHD then underwent follow­up echocardiography. The diagnosis and severity of re-reported baseline and follow-up echocardiograms were compared. 


There was one (1%) RHD-related death and 14 (20%) complications in the screening­-detected group. There were nine (13%) RHD­-deaths in the clinically-diagnosed group and 39 (56%) developed complications, and only 1 complication in the screen-negative group. The differences in mortality and complications were statistically significant by Kaplan-Meier analysis. Admission and surgery were more frequent in the screening-detected than screen-negative group. Ninety-eight participants were recruited for echocardiography (median follow­up, 7.5 years). 70% of definite RHD cases persisted or progressed, including four requiring surgery. 24% of borderline cases progressed to moderate-severe, definite RHD.


Young people with screening­-detected RHD have worse health outcomes than the screen­-negative population, whilst the prognosis of clinically-­diagnosed RHD in Fiji remains very poor. Most definite RHD cases persist on echocardiography, and others may require surgery or succumb. Close follow-up and individualised consideration of prophylaxis is need for borderline cases.