Abstract
In 2013, Auckland District Health Board and the University of Otago collaborated to develop a project investigating rheumatic heart disease screening, which was funded as part of the Rheumatic Fever Partnership Programme (administered by the Health Research Council). This report explores one component of this project, which focused on describing the follow-up practice and procedures used in echocardiography studies which took place between 2007-2012.
In this report, we present data relating to the follow-up care and active surveillance of children diagnosed with rheumatic heart disease (RHD) as part of a series of RHD screening studies conducted in six District Health Boards between 2007-2012, during which time 142 children were classified as having either definite, probable, possible or borderline RHD. We followed these patients up until the end of 2014. By the end of the follow-up period, all of those with definite RHD remained under medical follow up, whilst 26% of probable, 44% of possible and 36% of borderline RHD were medically discharged. All (100%) of those with definite RHD and most of those with probable (96%), possible (89%) and borderline (81%) RHD received at least one repeat echocardiography scan following the screening test. We observed some heterogeneity in receipt of care according to which of the two screening criteria (‘modified’ and ‘WHF) was employed in a given region: for example, in those regions that utilised the ‘modified’ criteria, the median time between repeat scanning ranged from 86-138 days, compared with a median time of 413-727 days in those programmes utilising the WHF criteria. Such variation might be explained by study protocol evolution over the course of the pilot screening programme. Regarding antibiotic prophylaxis, all (100%) of those with definite and 96% of those with probable RHD promptly received antibiotic prophylaxis; while 21% of possible and 7% of borderline RHD went onto receive prophylaxis over the follow-up period.