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Pilot study of nurse-led rheumatic heart disease echocardiography screening in Fiji – a novel approach in a resource-poor setting

Published online by Cambridge University Press:  08 October 2012

Samantha M. Colquhoun ,
Jonathan R. Carapetis ,
Joseph H. Kado ,
Benjamin M. Reeves ,
Boglarka Remenyi ,
William May ,
Nigel J. Wilson  and
Andrew C. Steer
Samantha M. Colquhoun*
Affiliation:
International Health Division, Menzies School of Health Research, Darwin, Australia Centre for International Child Health, University of Melbourne, Melbourne, Australia
Jonathan R. Carapetis
Affiliation:
International Health Division, Menzies School of Health Research, Darwin, Australia
Joseph H. Kado
Affiliation:
Department of Paediatrics, Fiji Ministry of Health, Suva, Fiji
Benjamin M. Reeves
Affiliation:
Department of Paediatric Cardiology, Cairns Base Hospital, Cairns, Australia
Boglarka Remenyi
Affiliation:
International Health Division, Menzies School of Health Research, Darwin, Australia Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
William May
Affiliation:
College of Medicine, Nursing and Health Sciences, Fiji National University, Lautoka, Fiji
Nigel J. Wilson
Affiliation:
Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
Andrew C. Steer
Affiliation:
Centre for International Child Health, University of Melbourne, Melbourne, Australia
*
Correspondence to: MS. Samantha Colquhoun, BA, RN, MPH (PhD Scholar), Centre for International Child Health, East Level 2 Royal Children's Hospital, Flemington Road, Parkville 3052, Australia. Tel:+61 3 9345 4977; Fax: +61 3 9345 6667; E-mail: [email protected]
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Abstract

We designed a pilot study of a training module for nurses to perform rheumatic heart disease echocardiography screening in a resource-poor setting. The aim was to determine whether nurses given brief, focused, basic training in echocardiography could follow an algorithm to potentially identify cases of rheumatic heart disease requiring clinical referral, by undertaking basic two-dimensional and colour Doppler scans. Training consisted of a week-long workshop, followed by 2 weeks of supervised field experience. The nurses’ skills were tested on a blinded cohort of 50 children, and the results were compared for sensitivity and specificity against echocardiography undertaken by an expert, using standardised echocardiography definitions for definite and probable rheumatic heart disease. Analysis of the two nurses’ results revealed that when a mitral regurgitant jet length of 1.5 cm was used as the trigger for rheumatic heart disease identification, they had a sensitivity of 100% and 83%, respectively, and a specificity of 67.4% and 79%, respectively. This pilot supports the principle that nurses, given brief focused training and supervised field experience, can follow an algorithm to undertake rheumatic heart disease echocardiography in a developing country setting to facilitate clinical referral with reasonable accuracy. These results warrant further research, with a view to developing a module to guide rheumatic heart disease echocardiographic screening by nurses within the existing public health infrastructure in high-prevalence, resource-poor regions.

Keywords

Developing countriesscreeningpublic health
Type
Original Articles
Information
Cardiology in the Young , Volume 23 , Issue 4 , August 2013 , pp. 546 - 552
Copyright
Copyright © Cambridge University Press 2012 

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References

1. Steer, AC, Kado, J, Jenney, AW, et al. Acute rheumatic fever and rheumatic heart disease in Fiji: prospective surveillence, 2005–2007. Med J Aust 2009; 190: 133–135.Google Scholar
2. Reeves, BM, Kado, JH, Brook, M. High prevalence of rheumatic heart disease in Fiji detected by echocardiography screening. J Paediatr Child Health 2011; 47: 473–478.Google Scholar
3. Paar, JA, Berrios, NM, Rose, JD, et al. Prevalence of rheumatic heart disease in children and young adults in Nicaragua. Am J Cardiol 2010; 105: 1809–1814.CrossRefGoogle Scholar
4. Carapetis, JR, Hardy, M, Fakakovikaetau, T, et al. Evaluation of a screening protocol using auscultation and portable echocardiography to detect aysmtomatic rheumatic heart disease in Tongan school children. Nat Clin Pract Cardiovasc Med 2008; 5: 411–417.Google Scholar
5. Webb, R, Wilson, NJ, Lennon, DR, et al. Optimising echocardiographic screening for rheumatic heart disease in New Zealand: not all valve disease is rheumatic. Cardiol Young 2011; 21: 436–443.Google Scholar
6. Marijon, E, Ou, P, Celermajer, DS, et al. Prevalence of rheumatic heart disease detected by echocardiographic screening. N Engl J Med 2007; 357: 470–476.Google Scholar
7. Bhaya, M, Panwar, S, Beniwal, R, Panar, PB. High prevalence of rheumatic heart disease detected by echocardiography in school children. Echocardiography 2010; 27: 448–453.Google Scholar
8. WHO Expert Consultation on Rheumatic Fever and Rheumatic Heart Disease (2001: Geneva, Switzerland); Rheumatic fever and rheumatic heart disease: report of a WHO Expert Consultation, Geneva, 29 October – 1 November 2001. (WHO technical report series; 923 published 20030, p 112.)Google Scholar
9. Tompkins, DG, Boxerbaum, B, Liebman, J. Long-term prognosis of rheumatic fever patients receiving regular intramuscular benzathine penicillin. Circulation 1972; 45: 543–551.Google Scholar
10. Stollerman, GH, Rusoff, JH, Hirschfeld, I. Prophylaxis against group A streptococci in rheumatic fever; the use of single monthly injections of benzathine penicillin G. N Engl J Med 1955; 252: 787–792.Google Scholar
11. Feinstein, AR, Stern, EK, Spagnuolo, M. The prognosis of acute rheumatic fever. Am Heart J 1964; 68: 817–834.Google Scholar
12. Sanyal, SK, Berry, AM, Duggal, S, Hooja, V, Ghosh, S. Sequelae of the initial attack of acute rheumatic fever in children from north India. A prospective 5-year follow-up study. Circulation 1982; 65: 375–379.Google Scholar
13. Majeed, HA, Batnager, S, Yousof, AM, Khuffash, F, Yusuf, AR. Acute rheumatic fever and the evolution of rheumatic heart disease: a prospective 12 year follow-up report. J Clin Epidemiol 1992; 45: 871–875.CrossRefGoogle ScholarPubMed
14. Carapetis, JR, Paar, J, Cherian, T. Standardization of epidemiologic protocols for surveillence of post-streptococcal sequelae: acute rheumatic fever, rheumatic heart disease and acute post-streptococcal glomerulonephritis. In: Protocols for surveillance of Streptococcal pyogenes infections and their sequelae. National Institutes of Health, Bethesda, USA, 2010. http://www.niaid.nih.gov/topics/streptococcal/pages/protocols.aspx, accessed 10 September 2012.Google Scholar
15. Remenyi, B, Wilson, N, Steer, A, et al. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease – an evidence-based guideline. Nat Rev Cardiol 2012, 5: 297–309.CrossRefGoogle Scholar