Integrated community-based screening for cardiovascular diseases of childhood.

ABSTRACT

PIP: Rheumatic fever and rheumatic heart disease (RF/RHD) and congenital heart disease cause considerable disability and mortality among children, especially in developing countries. In the Shimla Hills of northern India, integrated first-level symptom-based screening for cardiovascular diseases has been conducted in 15,080 schoolchildren aged 5-16 years, with good results. Histories of fever, sore throat, swollen or painful joints, breathlessness, fatigue, and involuntary movements were noted. A physician then looked for objective evidence of RF/RHD, congenital heart disease, or functional murmur in all of the children. When any of those conditions was suspected, the cases were referred to a cardiologist at a tertiary care center, where detailed investigations were conducted. There were 45 cases of RF/RHD, 912 of functional murmur, and 34 of congenital heart disease. Traditional secondary prophylaxis programs for RF/RHD usually exclude congenital heart disease cases even though they also need treatment. This strategy used in Shimla Hills is more ethical and cost-effective than screening programs concerned exclusively with the control of RF/RHD.