Send letter to journal:
Re: Status of rheumatic heart disease in Pakistan - An Underestimate ?

Dear Editor

We read Rizvi et al's article on the status of rheumatic heart disease (RHD) in rural Pakistan with considerable interest.[1]

Rizvi and colleagues highlight an extremely important problem facing cardiologists in Pakistan. However, it is possible that the true prevalence of RHD in this population may have been underestimated as echocardiography was only performed in those with an audible murmur. Although the concordance between auscultation by experienced cardiologists (such as the authors) and echocardiography is fairly robust, auscultation is an operator- dependent skill which is difficult to quantify. Furthermore, very early RHD, particularly mitral valve disease, may be missed even by highly experienced auscultators. The economics of performing an echocardiogram in over 9000 subjects is clearly prohibitive; however, a random echocardiographic verification of a prespecified number of patients deemed to have "no RHD" by auscultation would have enhanced the robustness of this estimate.

Rizvi et al. very appropriately point out the lack of initiative at the government level to take measures to both, reduce the prevalence of this disease as well as improve health care delivery to those afflicted with RHD.

Reference

1. S F Rizvi, M A Khan, A Kundi, D R Marsh, A Samad, and O Pasha Status of rheumatic heart disease in rural Pakistan Heart 2004; 90: 394-399.