Response to Letters Regarding Article, “Echocardiography Screening for Rheumatic Heart Disease in Ugandan Schoolchildren”
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Many thanks are given to Drs Mayosi, Kothari, and Pilgrim for their sustained attention to rheumatic heart disease (RHD) and careful review of our article.1
Their letters—and our article, we hope—strike a common chord: the need for longitudinal study of children diagnosed with subclinical rheumatic carditis.
We agree that echocardiographic screening for RHD poses a risk of overdiagnosis, the extent of which must be measured through serial follow-up. For now, it bears emphasis that echocardiographic screening is only appropriate where the baseline probability of disease is high. The 2012 World Heart Federation criteria concur in this recommendation; they attempt to improve accuracy by providing the first evidence-based guidelines for screening children without a history of acute rheumatic fever (ARF).2 Concerns about the stigma of false diagnosis are legitimate, but our experience suggests that we can follow possible or borderline RHD patients without them being labeled as chronically diseased. In fact, high compliance rates and positive feedback indicate that families are happy to attend frequent follow-up despite the uncertainty associated with the child's provisional diagnosis.
Similarly, important and …