Effectiveness of Systematic Echocardiographic Screening for Rheumatic Heart Disease in Nepalese Schoolchildren: A Cluster Randomized Clinical Trial.
Effectiveness of Systematic Echocardiographic Screening for Rheumatic Heart Disease in Nepalese Schoolchildren: A Cluster Randomized Clinical Trial.
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DOI：
10.1001/jamacardio.2020.7050
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发表时间：
2021-04-01
期刊：
影响因子：
24
通讯作者：
Pilgrim T
中科院分区：
文献类型：
--
作者：
Karki P;Uranw S;Bastola S;Mahato R;Shrestha NR;Sherpa K;Dhungana S;Odutayo A;Gurung K;Pandey N;Agrawal K;Shah P;Rothenbühler M;Jüni P;Pilgrim T
在风湿性心脏病流行地区对学龄儿童进行超声心动图筛查，然后对有亚临床风湿性心脏病证据的儿童进行二级抗生素预防，是否能有效降低风湿性心脏病的患病率？这项随机分组临床试验发现，干预后4年进行超声心动图筛查的学校与未进行筛查的对照学校相比，明确或临界风湿性心脏病的患病率无统计学显著性降低。对实验学校的辅助性重复横断面分析发现，明确或临界风湿性心脏病的几率显着降低。风湿性心脏病的患病率较低的学校与以前的超声心动图筛查值得进一步研究的有效性，早期发现和及时治疗儿童和青少年的风湿性心脏病。超声心动图筛查可早期发现风心病流行地区儿童的亚临床期。探讨系统性超声心动图筛查联合二级抗生素预防对风湿性心脏病患病率的有效性。这项随机分组临床试验包括2012年11月17日随机选择的尼泊尔Sunsari县城乡地区公立和私立学校9至16岁的学生。2016年1月7日至2019年1月3日进行了超声心动图随访。在实验组中，儿童进行系统的超声心动图筛查，其次是二级抗生素预防的情况下，他们有潜在的风湿性心脏病的超声心动图证据。在对照组中，儿童不接受超声心动图筛查。干预4年后，根据世界心脏联合会标准，在实验学校和对照学校评估明确或临界风湿性心脏病的复合患病率。共有35所学校被随机分为实验组（n = 19）和控制组（n = 16）。平均4.3年后（四分位距[IQR]，4.0-4.5岁），实验组19所学校中的17所（2648名儿童;随访时的中位年龄，12.1岁; IQR，10.3-12.5岁; 1308名[49.4%]男性）和对照组16所学校中的15所（1325名儿童;随访时的中位年龄，10.6岁; IQR，10.0-12.5岁; 682名[51.5%]男性）进行了超声心动图随访。对照组中明确或临界风湿性心脏病的患病率为10.8/1000名儿童（95%CI，4.7-24.7），实验组为3.8/1000名儿童（95%CI，1.5-9.8）（比值比，0.34; 95%CI，0.11-1.07; P = 0.06）。基线时实验组的患病率为12.9/1000名儿童（95%CI，9.2-18.1）。在实验组中，随访时明确或临界风湿性心脏病与基线相比的比值比为0.29（95%CI，0.13-0.65; P = 0.008）。以学校为基础的超声心动图筛查与二级抗生素预防相结合的儿童的证据，潜在的风湿性心脏病可能是一个有效的策略，以减少流行地区的明确或临界风湿性心脏病的患病率。ClinicalTrials.gov 标识符：NCT 01550068这项随机分组临床试验研究了系统性超声心动图筛查联合二级抗生素预防对尼泊尔学龄儿童风湿性心脏病患病率的影响。
Is echocardiographic screening of schoolchildren in regions with an endemic pattern of rheumatic heart disease followed by secondary antibiotic prophylaxis in children with evidence of subclinical rheumatic heart disease effective in reducing the prevalence of rheumatic heart disease? This cluster randomized clinical trial found a nonstatistically significant lower prevalence of definite or borderline rheumatic heart disease in schools with echocardiographic screening 4 years after intervention compared with control schools with no previous screening. An auxiliary repeated cross-sectional analysis of experimental schools found a significant reduction in the odds of definite or borderline rheumatic heart disease. A lower prevalence of rheumatic heart disease in schools with prior echocardiographic screening warrants further study of the effectiveness of early detection and timely treatment of rheumatic heart disease in children and adolescents. Echocardiographic screening allows for early detection of subclinical stages of rheumatic heart disease among children in endemic regions. To investigate the effectiveness of systematic echocardiographic screening in combination with secondary antibiotic prophylaxis on the prevalence of rheumatic heart disease. This cluster randomized clinical trial included students 9 to 16 years of age attending public and private schools in urban and rural areas of the Sunsari district in Nepal that had been randomly selected on November 17, 2012. Echocardiographic follow-up was performed between January 7, 2016, and January 3, 2019. In the experimental group, children underwent systematic echocardiographic screening followed by secondary antibiotic prophylaxis in case they had echocardiographic evidence of latent rheumatic heart disease. In the control group, children underwent no echocardiographic screening. Prevalence of the composite of definite or borderline rheumatic heart disease according to the World Heart Federation criteria in experimental and control schools as assessed 4 years after intervention. A total of 35 schools were randomized to the experimental group (n = 19) or the control group (n = 16). After a median of 4.3 years (interquartile range [IQR], 4.0-4.5 years), 17 of 19 schools in the experimental group (2648 children; median age at follow-up, 12.1 years; IQR, 10.3-12.5 years; 1308 [49.4%] male) and 15 of 16 schools in the control group (1325 children; median age at follow-up, 10.6 years; IQR, 10.0-12.5 years; 682 [51.5%] male) underwent echocardiographic follow-up. The prevalence of definite or borderline rheumatic heart disease was 10.8 per 1000 children (95% CI, 4.7-24.7) in the control group and 3.8 per 1000 children (95% CI, 1.5-9.8) in the experimental group (odds ratio, 0.34; 95% CI, 0.11-1.07; P = .06). The prevalence in the experimental group at baseline had been 12.9 per 1000 children (95% CI, 9.2-18.1). In the experimental group, the odds ratio of definite or borderline rheumatic heart disease at follow-up vs baseline was 0.29 (95% CI, 0.13-0.65; P = .008). School-based echocardiographic screening in combination with secondary antibiotic prophylaxis in children with evidence of latent rheumatic heart disease may be an effective strategy to reduce the prevalence of definite or borderline rheumatic heart disease in endemic regions. ClinicalTrials.gov Identifier: NCT01550068 This cluster randomized clinical trial investigates the effect of systematic echocardiographic screening in combination with secondary antibiotic prophylaxis on the prevalence of rheumatic heart disease in schoolchildren in Nepal.
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