Long-term outcomes following rheumatic heart disease diagnosis in Australia

Abstract

Aims Rheumatic Heart Disease (RHD) is a major contributor to cardiac morbidity and mortality globally. We aimed to estimate the probability and predictors of progressing to non-fatal cardiovascular complications and death in young Australians after first RHD diagnosis. Methods and Results This retrospective cohort study used linked RHD register, hospital and death data from five Australian states and territories (covering 70% of the whole population and 86% of the Indigenous population). Progression from uncomplicated RHD to all-cause death and non-fatal cardiovascular complications (surgical intervention, heart failure, atrial fibrillation, infective endocarditis, stroke) was estimated for people aged <35years with first-ever RHD diagnosis between 2010 and 2018, identified from register and hospital data. The study cohort comprised 1718 initially uncomplicated RHD cases (84.6% Indigenous; 10.9% migrant; 63.2% women; 40.3% aged 5-14-years; 76.4% non-metropolitan). The composite outcome of death/cardiovascular complication was experienced by 23.3% (95% CI: 19.5-26.9) within 8 years. Older age and metropolitan residence were independent positive predictors of the composite outcome; history of acute rheumatic fever (ARF) was a negative predictor. Population group (Indigenous/migrant/other Australian) and sex were not predictive of outcome after multivariable-adjustment. Conclusion This study provides the most definitive and contemporary estimates of progression to major cardiovascular complication or death in young Australians with RHD. Despite access to the publically-funded universal Australian healthcare system, one-fifth of initially uncomplicated RHD cases will experience one of the major complications of RHD within 8 years supporting the need for programs to eradicate RHD.

Rheumatic heart disease mortality in Indigenous and non-Indigenous Australians between 2013 and 2017

“…In Australia, morbidity and mortality from RHD are exemplars of health inequities based in social disadvantage, with ≈23% of people aged <35 years (>84% Indigenous) with initially uncomplicated RHD experiencing atrial fibrillation, heart failure, infective endocarditis, stroke or death within 8 years of their diagnosis 4. Additionally, >520 RHD deaths are projected to occur in Australian First Nations people (Aboriginal and Torres Strait Islanders, hereafter respectfully ‘Indigenous’) between 2016 and 2031 5.…”

Rheumatic Heart Disease among Patients with Valvular Heart Disease Admitted to the In-patient Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study

“… 15 One-fifth of initially uncomplicated RHD cases aged 35 years advanced to death/non-fatal complication within 8 years, according to a study, and the complication risk was highest within the first 6 months after RHD diagnosis. 16 …”

“…Age >14 years, metropolitan residence, and a prior Acute Rheumatic Fever (ARF) record were all found to be independent predictors of RHD progression, although sex and population group were not in an Australian cohort. 16 …”

Population-based assessment of cardiovascular complications of rheumatic heart disease in Fiji: a record-linkage analysis

“…15 However, as the authors of that study noted, since the patients were mostly enrolled at tertiary referral hospitals, the rates observed cannot be easily generalised to the wider pool of patients with RHD away from hospital settings. 15 Furthermore, neither REMEDY nor more recent studies of RHD progression provide estimates of population-based rates of complications of RHD, [16][17][18][19] which are needed to improve current global summary estimates as well as to inform the design, implementation and evaluation of disease control efforts. 13 20 Therefore we sought to assess the burden and calculate nationwide population-based rates of RHD-attributable morbidity in Fiji, a middle-income country in the Western Pacific.…”