Background: The 2023 World Heart Federation (WHF) guidelines introduced abbreviated screening criteria for early rheumatic heart disease (RHD) detection in high-risk populations.1 The diagnostic performance of these criteria remains unestablished. Here, we determine the diagnostic accuracy of the WHF screening criteria in a high-risk population.
Methods: Ugandan children (aged 5–17 years) were screened for RHD based on WHF criteria by a team of trained nurses using hand-held echocardiography and a 5-view protocol. All screen-positive and a random sample of screen-negative children underwent confirmatory echocardiography, with results adjudicated by a 7-member expert panel. The primary outcome was the diagnostic accuracy of the WHF screening criteria compared to expert adjudication as the reference standard.
Results: Of 10,676 children screened in one quarter, 522 (4.9%) were positive. The expert panel diagnosed 96 RHD cases and 408 normal results among screen-positive children; and 25 RHD cases and 3,273 normal results among 3,301 screen-negative children. Sensitivity, specificity, negative and positive predictive values (95% CI) for the WHF screening criteria against expert panel adjudication were 0.79 (0.73-0.87), 0.89 (0.88-0.90), 0.99 (0.99-1.0), and 0.19 (0.15-0.23) respectively.
Discussion: The WHF screening criteria demonstrate high specificity and negative predictive value, effectively ruling out RHD. While sensitivity is acceptable, up to 20% of RHD cases may be missed during rapid screening. Further studies are needed to optimize screening accuracy, considering factors such as criteria design, training, and equipment.