Project Details

Determining the Risk of Rheumatic Heart Disease Following Prophylaxis Discontinuation (GOAL-Keep)

Joselyn Rwebembera, MD

Summary

BACKGROUND: Secondary antibiotic prophylaxis (SAP) is a cornerstone of rheumatic heart disease (RHD) prevention, but lengthy courses of treatment impose significant burden on patients, families, and healthcare systems. GAP: There is limited data on the longer-term safety of discontinuing SAP among children with mild screen-detected RHD who show echocardiographic normalization or persistent mild but stable disease. HYPOTHESIS: Among children and adolescents diagnosed with mild RHD by echocardiographic screening, we hypothesize that (1) the risk for developing moderate/severe (Stage C/D) RHD after echocardiographic stability (2 years) is very low, 3 years after SAP discontinuation and (2) the risk for developing moderate/severe (Stage C/D) RHD after echocardiographic normalization is very low, 6 years after SAP discontinuation. METHODS: GOAL-Keep is a prospective observational cohort study to determine the risk of developing moderate/severe RHD after SAP discontinuation among children and adolescents who were diagnosed with mild RHD, and now with echocardiographic stability (2 years) or normalization. RESULTS: Pending. IMPACT: A more nuanced approach to SAP after a diagnosis of mild, screen-detected RHD, which includes the possibility of a shortened course of SAP (based on echocardiographic findings) would represent a substantial advancement in the feasibility of SAP for RHD control. GOAL-Keep is both timely and essential to ensure that emerging recommendations represent best practice care for children and adolescents living with RHD. Website Link: https://www.rrcuganda.org/