Detection and Treatment of Asymptomatic Patients With Congenital Heart Defects in China and Cambodia: Data From an International Screening and Intervention Project

Background: A considerable amount of children and adolescents suffering from asymptomatic congenital heart disease (CHD) were left in community, due to poor health-related resources and consciousness, particularly in low- and middle- income countries. Thus, we aimed to determine the prevalence of asymptomatic CHD in China and Cambodia, as well as to evaluate the gaps in patients' growth status and the effects of the treatment. Methods: In this study, we sampled kindergartens and schools from 8 provinces in China and 5 provinces in Cambodia. In children and adolescents aged 3-18 years, physical signs and heart sounds were examined, then further echocardiography were conducted to detect the CHD that needs treatment. After treatment, patients were followed up for 1 year to assess the gaps in their height and weight to the standard line. Findings: In the 3 068 075 participants screened (3 015 470 in China and 52 605 in Cambodia), 3891 patients with asymptomatic CHD in need of treatment [0·12%, 95% confidence interval (CI) 0·12%-0·13%] were identified. The prevalence of asymptomatic CHD were slightly lower in China than in Cambodia (0·12% vs. 0·16%, p=0·017). Among the 64 screening sites, the county (district) level prevalence of asymptomatic CHD ranged from 0·02% to 0·88%, which were negatively associated with local per capital GDP (p=0·028), but not significantly related with the local average altitude (p>0·05). Among 3310 treated CHD patients, the height was lower than the standard level at their age -2·23% (95% CI: -2·54%~-1·93%, while the weight gap was -6·41% (95% CI: -7·17%~-5·65%), which have been broadening with age of diagnosis. One year after the treatment, the relative gap in height had persisted, and the relative gap in weight had narrowed by 5·68% (95% CI: 4·27%~7·09%), with the “catching-up” steps bigger in patients who were younger at the treatment. The patterns were consistent between the Chinese and Cambodian patients. Interpretation: Asymptomatic CHD still causes notable public health issue in developing countries. Through timely detection and treatment, the potential burden of children and adolescents could be substantially mitigated. Funding Information: This project was supported by the National Key Research and Development Program of China (grant No. 2018YFC1315501), Yunnan Provincial Clinical Research Center Project (Grant No. FZX2019-06-01) and “Love Heart Journey” project. Declaration of Interests: The authors declared no relevant conflict of interest. Ethics Approval Statement: The ethics committee at the Fuwai Yunnan Cardiovascular Hospital approved this project. All patients who received treatment and were followed have provided written informed consent.