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.

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Cardiovascular complications in newly diagnosed rheumatic heart disease patients at Mulago Hospital, Uganda : cardiovascular topics

CardioVascular Journal of Africa ◽

10.5830/cvja-2013-004 ◽

2013 ◽

Vol 24 (3) ◽

pp. 76-79 ◽

Cited By ~ 36

Author(s):

Emmy Okello ◽

Zhang Wanzhu ◽

Charles Musoke ◽

Aliku Twalib ◽

Barbara Kakande ◽

...

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

Cardiovascular Complications ◽

Mulago Hospital ◽

Newly Diagnosed ◽

Rheumatic Heart

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The utility of handheld echocardiography for early rheumatic heart disease diagnosis: a field study

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeu296 ◽

2015 ◽

Vol 16 (5) ◽

pp. 475-482 ◽

Cited By ~ 61

Author(s):

Andrea Beaton ◽

Jimmy C. Lu ◽

Twalib Aliku ◽

Peter Dean ◽

Lasya Gaur ◽

...

Keyword(s):

Heart Disease ◽

Field Study ◽

Rheumatic Heart Disease ◽

Disease Diagnosis ◽

Heart Disease Diagnosis ◽

Rheumatic Heart

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Problems of chronic rheumatic heart disease diagnosis at the present stage

Clinical Medicine (Russian Journal) ◽

10.30629/0023-2149-2021-99-4-259-265 ◽

2021 ◽

Vol 99 (4) ◽

pp. 259-265

Author(s):

G. V. Santalova ◽

P. A. Lebedev ◽

A. A. Garanin ◽

M. E. Kuzin

Keyword(s):

Heart Disease ◽

Rheumatic Fever ◽

Rheumatic Heart Disease ◽

Acute Rheumatic Fever ◽

Disease Diagnosis ◽

Present Stage ◽

Screening Programs ◽

Ultrasound Diagnostics ◽

The World ◽

Rheumatic Heart

The review refl ects modern data on the epidemiology of acute rheumatic fever and chronic rheumatic heart disease in Russia and the world at present, as well as the dynamics of the prevalence of these diseases over the past decades. Much attention is paid to the issues of modern diagnostics of these conditions by physical, laboratory and instrumental methods. The focus is on the Jones criteria in the diagnosis of acute rheumatic fever in accordance with their revision by the American Heart Association experts in 2015. Taking into account the fact that damage to the valvular apparatus of the heart in acute rheumatic fever is the main disabling outcome of carditis at the present stage, a special place in the article is devoted to the discussion of echocardiographic criteria for valvulitis. The recommendations of the International Expert Council of the World Heart Federation aimed at detecting chronic rheumatic heart disease in patients without a history of acute rheumatic fever diagnosed by ultrasound imaging are also given. Criteria for pathological aortic and mitral regurgitation are presented. The authors believe that extrapolation of modern principles of ultrasound diagnostics of chronic rheumatic heart disease in Russia and their use as screening programs in young people and adolescents will contribute to its early detection and timely selection of patients for secondary prevention of benzathine with benzylpenicillin.

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Case Ascertainment on Australian Registers for Acute Rheumatic Fever and Rheumatic Heart Disease

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17155505 ◽

2020 ◽

Vol 17 (15) ◽

pp. 5505

Author(s):

Treasure Agenson ◽

Judith M. Katzenellenbogen ◽

Rebecca Seth ◽

Karen Dempsey ◽

Mellise Anderson ◽

...

Keyword(s):

Heart Disease ◽

Rheumatic Fever ◽

Rheumatic Heart Disease ◽

Disease Surveillance ◽

Acute Rheumatic Fever ◽

South Australia ◽

Hospital Data ◽

Indigenous Status ◽

Case Ascertainment ◽

Rheumatic Heart

In Australia, disease registers for acute rheumatic fever (ARF) and rheumatic heart disease (RHD) were previously established to facilitate disease surveillance and control, yet little is known about the extent of case-ascertainment. We compared ARF/RHD case ascertainment based on Australian ARF/RHD register records with administrative hospital data from the Northern Territory (NT), South Australia (SA), Queensland (QLD) and Western Australia (WA) for cases 3–59 years of age. Agreement across data sources was compared for persons with an ARF episode or first-ever RHD diagnosis. ARF/RHD registers from the different jurisdictions were missing 26% of Indigenous hospitalised ARF/RHD cases overall (ranging 17–40% by jurisdiction) and 10% of non-Indigenous hospitalised ARF/RHD cases (3–28%). The proportion of hospitalised RHD cases (36%) was half the proportion of hospitalised ARF cases (70%) notified to the ARF/RHD registers. The registers were found to capture few RHD cases in metropolitan areas (SA Metro: 13%, QLD Metro: 35%, WA Metro: 14%). Indigenous status, older age, comorbidities, drug/alcohol abuse and disease severity were predictors of cases appearing in the hospital data only (p < 0.05); sex was not a determinant. This analysis confirms that there are biases associated with the epidemiological analysis of single sources of case ascertainment for ARF/RHD using Australian data.

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Mobile phone-based rheumatic heart disease diagnosis

Appropriate Healthcare Technologies for Low Resource Settings (AHT 2014) ◽

10.1049/cp.2014.0761 ◽

2014 ◽

Cited By ~ 2

Author(s):

D.B. Springer ◽

L.J. Zühlke ◽

L. Tarassenko ◽

B.M. Mayosi ◽

G.D. Clifford

Keyword(s):

Heart Disease ◽

Mobile Phone ◽

Rheumatic Heart Disease ◽

Disease Diagnosis ◽

Heart Disease Diagnosis ◽

Rheumatic Heart

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Modelling rheumatic heart disease progression in australia using disease register data linked to administrative records

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.109 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

I Stacey ◽

J Hung ◽

K Murray ◽

R Seth ◽

D Bond-Smith ◽

...

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Disease Progression ◽

Rheumatic Heart Disease ◽

Surgical Intervention ◽

Cardiovascular Complications ◽

Sensitivity Analyses ◽

Indigenous Australians ◽

Complication Rates ◽

Rheumatic Heart

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Australian Government National Health and Medical Research Council OnBehalf ERASE project Background Rheumatic Heart Disease (RHD) is a major contributor to morbidity and mortality globally, and is endemic among Indigenous Australians. The RHD Endgame strategy was recently launched, outlining comprehensive methods for eliminating RHD in Australia by 2031. However, there is currently limited information on national rates of RHD and progression to severe or complicated RHD. Purpose This study provides current estimates of RHD progression prior to RHD Endgame Strategy implementation. We estimate the probability and predictors of progressing from RHD diagnosis to cardiovascular complications, death, or need for surgical intervention in the Australian population from expanded data sources, addressing methodological shortcomings in existing evidence by using cross-jurisdictional administrative datasets and a competing risks approach. Methods This retrospective cohort study used linked RHD register, hospital and death data from five Australian jurisdictions (>70% Australians). Progression from RHD diagnosis to all-cause mortality, non-fatal cardiovascular complications (heart failure, stroke, endocarditis, atrial fibrillation), or need for surgical intervention were estimated for people aged <35years diagnosed with first-ever RHD between 2010 and 2018. A minimum 8.5-year look-back excluded prevalent cases; maximum follow-up was 8 years. Proportional cause-specific hazard regression modelling investigated independent predictors of outcomes, with death treated as a competing risk. Sensitivity analyses compared results between all-sources and register-only cohorts. Results We identified 1714 first-ever RHD cases aged <35years in the all-sources cohort (84% Indigenous, 11% migrant, 63% women, 40% age 5-14years, 85% non-metropolitan). Six months after diagnosis, 8.1% (95%CI:6.9-9.5%) had experienced heart failure, other cardiovascular complications or surgical intervention and 23.6% (95%CI:20.2-27.5%) progressed to these outcomes within 8 years. The register-only cohort experienced less disease progression with estimated composite event rates of 5.6% (95%CI:4.7-6.6%) and 18.4% (95%CI:16.6-20.5%) at 6 month and 8 years respectively. Death rate in the all-sources cohort was 0.5% at 6 months and 3.2% at 8 years. Older age, Metropolitan residence, and history of acute rheumatic fever, but not sex or Indigenous status, were independent predictors of major cardiovascular outcomes. Conclusions This study provides the most definitive and contemporary estimates of RHD disease progression in young Australians. Despite Australia"s excellent healthcare system infrastructure, RHD complication rates remain high. Improvements in healthcare systems for diagnosis, monitoring, and management of RHD cases will need to be implemented in both Metropolitan and remote settings as Australia implements its Endgame strategy against RHD. However, primordial and primary prevention provides the best potential to reduce the burden of RHD in Australia and beyond.

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Pioneering Methods Developed to Investigate the Burden of Acute Rheumatic Fever and Rheumatic Heart Disease Using Multiple Linked Data Sources

International Journal for Population Data Science ◽

10.23889/ijpds.v5i5.1632 ◽

2020 ◽

Vol 5 (5) ◽

Author(s):

Rebecca Seth ◽

Daniela Bond-Smith ◽

Judith Katzenellenbogan

Keyword(s):

Heart Disease ◽

Rheumatic Fever ◽

Rheumatic Heart Disease ◽

Linked Data ◽

Hospital Admissions ◽

Data Sources ◽

Health Concern ◽

Prediction Algorithm ◽

Hospital Data ◽

Rheumatic Heart

IntroductionAcute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD) remain a major public health concern in Australia. Government action requires reliable burden estimates, however data from single or unlinked sources are only partial and likely to be skewed, exacerbated by systemic problems with ICD-10 codes for RHD. Linked data provide an opportunity to address these shortcomings. Objectives and ApproachObjectives: to develop a methodology using harmonised linked data across five Australian jurisdictions to determine the burden of ARF and RHD <55 years, in particular robust case definitions for calculating incidence and prevalence. For identifying RHD in hospital-only patients, validated case and non-cases from non-hospital sources were used with linked inpatient hospital admissions to develop a RHD prediction model. Additional data sources (register and surgery databases) were used to identify cases for reporting RHD prevalence. A unique ARF episode was defined as an ARF record >90 days from the previous one across both register and hospital data. For first-ever episodes we applied a lookback to mid-2001 for both ARF and RHD. For Western Australia, we evaluated the effect of look-back period on prevalence pooling. ResultsFor total ARF incidence over 3 years (2015-2017), there was 1425 episodes compared to 1027 episodes for first-ever ARF. There was an annual average of 5241 cases of RHD identified using our new methods (0-54yrs) – substantially higher than 2634 and 4255 RHD cases reported by Global Burden of Disease Study and Australian Institute of Welfare estimates respectively for 2017. Increased lookback had no effect on first-ever ARF but increased RHD prevalence >25 years. Conclusion / ImplicationsBy using multiple sources and cross-jurisdictional data we were able to provide contemporary and robust estimates for the burden of ARF and RHD in Australia. The prediction algorithm we developed can also be used in other countries, where only hospital data is available, to quantify RHD burden.

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