Impact of ivabradine on dyspnea in patient with moderate mitral stenosis in sinus rhythm

Background: The lack of surveillance system is a major barrier in prevention and control of rheumatic fever/rheumatic heart disease (RF/RHD).Efficacy of school-based surveillance was evaluated for detection of acute pharyngitis and RF/RHD in Shimla district, HP.Methods: The schools in district Shimla were randomly assigned to intervention and controlled arm (442 vs. 441 schools).The trained nodal teachers reported children with symptoms of acute pharyngitis and or RF/ RHD in intervention arm and children taken to hospitals by parents for symptoms of acute pharyngitis and or RF/RHD under control arm through mobile phone to coordinating centre.Final outcome for presence of RF/ RHD or other heart Diseases was recorded after examination at nearest primary health centers and/or at Indira Gandhi Medical College Hospital, Shimla.Difference in detection rate between intervention arm and control arm was compared using Z test.Results: The number of school children reported from intervention group was significantly higher than in control due to suspected symptoms of acute pharyngitis and or RF/RHD were 65 (2.84/1000) and 15 (0.60/1000), respectively (p < 0.01).Only 4 children in each arm were found to have heart diseases, with prevalence of (0.17/1000 and 0.16/1000), respectively, after clinical and echocardiography evaluation.In intervention arm, one child had RHD while three had congenital heart disease; in control arm, one child had congenital heart disease and three had RHD.Conclusions: School based surveillance had higher rate of suspecting children with acute pharyngitis and or RF/RHD although with low specificity.There is a need of future studies to demonstrate the effectiveness of the proposed intervention in endemic regions of the state.