Echocardiographic prevalence of rheumatic heart disease in Brazilian schoolchildren: Data from the PROVAR study
Open accessAbstract
Background Accurate estimates of Rheumatic Heart Disease (RHD) burden are needed to justify improved integration of RHD prevention and screening into the public health systems, but data from Latin America are still sparse.Objective To determine the prevalence of RHD among socioeconomically disadvantaged youth (5-18years) in Brazil and examine risk factors for the disease.Methods The PROVAR program utilizes non-expert screeners, telemedicine, and handheld and standard portable echocardiography to conduct echocardiographic screening in socioeconomically disadvantaged schools in Minas Gerais, Brazil. Cardiologists in the US and Brazil provide expert interpretation according to the 2012 World Heart Federation Guidelines. Here we report prevalence data from the first 14months of screening, and examine risk factors for RHD.Results 5996 students were screened across 21 schools. Median age was 11.9 [9.0/15.0] years, 59% females. RHD prevalence was 42/1000 (n=251): 37/1000 borderline (n=221) and 5/1000 definite (n=30). Pathologic mitral regurgitation was observed in 203 (80.9%), pathologic aortic regurgitation in 38 (15.1%), and mixed mitral/aortic valve disease in 10 (4.0%) children. Older children had higher prevalence (50/1000 vs. 28/1000, p<0.001), but no difference was observed between northern (lower resourced) and central areas (34/1000 vs. 44/1000, p=0.31). Females had higher prevalence (48/1000 vs. 35/1000, p=0.016). Age (OR=1.15, 95% CI:1.10-1.21, p<0.001) was the only variable independently associated with RHD findings.Conclusions RHD continues to be an important and under recognized condition among socioeconomically disadvantaged Brazilian schoolchildren. Our data adds to the compelling case for renewed investment in RHD prevention and early detection in Latin America.
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Tele-ultrasound provides more cost-effective care.
“Tele-ultrasound has demonstrated success in producing high quality, diagnostically significant images which alter management, decrease time to treatment, and provide more cost-effective care, especially when coupled with supporting data such as electrocardiogram, chest radiography, laboratory results, and clinical history (29, 30, 33, 35, 37, 48).”
From Tele-Ultrasound in Resource-Limited Settings: A Systematic Review (2019) · cites this paper as [48]
The Discussion says that lower-cost handheld devices allowed more screeners to work in parallel, and that the PROVAR design has implications for cost and scalability. It does not demonstrate that tele-ultrasound provides more cost-effective care; the Discussion says further cost studies are needed and cost-effectiveness modeling is planned. (LLM, conf=0.86)
Experimental — accuracy not yet measuredTele-ultrasound has demonstrated success in producing high quality, diagnostically significant images.
“Tele-ultrasound has demonstrated success in producing high quality, diagnostically significant images which alter management, decrease time to treatment, and provide more cost-effective care, especially when coupled with supporting data such as electrocardiogram, chest radiography, laboratory results, and clinical history (29, 30, 33, 35, 37, 48).”
From Tele-Ultrasound in Resource-Limited Settings: A Systematic Review (2019) · cites this paper as [48]
Tele-ultrasound alters management.
“Tele-ultrasound has demonstrated success in producing high quality, diagnostically significant images which alter management, decrease time to treatment, and provide more cost-effective care, especially when coupled with supporting data such as electrocardiogram, chest radiography, laboratory results, and clinical history (29, 30, 33, 35, 37, 48).”
From Tele-Ultrasound in Resource-Limited Settings: A Systematic Review (2019) · cites this paper as [48]
Tele-ultrasound decreases time to treatment.
“Tele-ultrasound has demonstrated success in producing high quality, diagnostically significant images which alter management, decrease time to treatment, and provide more cost-effective care, especially when coupled with supporting data such as electrocardiogram, chest radiography, laboratory results, and clinical history (29, 30, 33, 35, 37, 48).”
From Tele-Ultrasound in Resource-Limited Settings: A Systematic Review (2019) · cites this paper as [48]
The PROVAR methods describe images uploaded weekly for remote interpretation, and the Discussion describes telemedicine for training and image review. Neither section reports time to treatment or compares it with care without tele-ultrasound. Searches for treatment timing, delays, and referral found no such result in our copy. (LLM, conf=0.74)
Experimental — accuracy not yet measured
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Self-citation
- Authors
- Nascimento, B. R., Beaton, A. Z., Nunes, M. C. P., Diamantino, A. C., Carmo, G. A. L., Oliveira, K. K. B., Oliveira, C. M., Meira, Z. M. A., Castilho, S. R. T., Lopes, E. L. V., Castro, I. M., Rezende, V. M. L. R., Chequer, G., Landay, T., Tompsett, A., Ribeiro, A. L. P., & Sable, C.
- Affiliations
- Universidade Federal de Minas Gerais (BR)
- Children's National (US)
- Hospital das Clínicas da Universidade Federal de Minas Gerais (BR)
- Corresponding author
- Nascimento, Bruno R.
- ORCID
- Venue
- International Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2016-09
- Volume
- 219
- Pages
- 439-445
- ISSN
- 0167-5273 (ISSN-L)
- OpenAlex
- W2469275093
- Cited by
- 81
- References
- 41
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 8 · 2023: 7 · 2022: 8 · 2021: 9 · 2020: 17 · 2019: 8 · 2018: 5 · 2017: 8 · 2016: 1
- FWCI
- 7.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
- Funders
- Conselho Nacional de Desenvolvimento Científico e Tecnológico (309073/2011-1)
- Financiadora de Estudos e Projetos
- Fundação de Amparo à Pesquisa do Estado de Minas Gerais (PPM-00161-13)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Keywords
- rheumatic heart disease, prevalence, elementary school students, echocardiographic screening, socioeconomic deprivation, mitral regurgitation, aortic regurgitation, risk factors, age, sex differences, telemedicine, handheld echocardiography, Minas Gerais
- MeSH terms
- Adolescent, Brazil, Child, Child, Preschool, Cross-Sectional Studies, Echocardiography, Female, Humans, Male, Prospective Studies, Rheumatic Heart Disease, Social Class, Students, Prevalence, Telemedicine, Vulnerable Populations
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