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

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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Rheumatic Fever and Rheumatic Heart Disease: A Physicians Perspective

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2019/v30i1130247 ◽

2019 ◽

pp. 1-12

Author(s):

Paul Nsirimobu Ichendu ◽

Duru Chika

Keyword(s):

Heart Disease ◽

Rheumatic Fever ◽

Rheumatic Heart Disease ◽

Acute Rheumatic Fever ◽

Group A Streptococcus ◽

Health Concern ◽

Public And Private ◽

Knowledge And Practice ◽

Study Participants ◽

Rheumatic Heart

Background: Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are non-suppurative cardiovascular sequlae of group A Streptococcus pharyngitis affecting children and young adults. Despite concerted efforts aimed at prevention, they still remain diseases of public health concern globally. Objectives: The aim of this study was to assess the knowledge and practice of acute rheumatic fever and rheumatic heart disease among physicians practicing in public and private hospitals in two states of the Niger delta region of Nigeria. Materials and Methods: Using a structured self administered questionnaire with 9 questions, 123 physicians from all the medical and surgical specialties were interviewed. Data was analyzed using SPSS 20. Results: Majority (95.93%) of the doctors were working in Government hospitals and nearly half (49.59%) of them were Paediatricians. Over half (50.41%) had more than 5 years’ experience in medical practice. Among the cadre of the doctors, house officers represented 44.72% while Consultants constituted 17.07% of the study participants. The study showed that 70 (56.91%) of the study participants selected at least seven correct answers out of the nine questions that assessed their knowledge and practice and so showed a good knowledge and practice of ARF and RHD. Conclusion: Though a good level of knowledge and practice was gotten from our study, there are still some gaps in the knowledge and practice that can be improved by health education through training and retraining our healthcare professionals. We therefore recommend the inclusion of ARF and RHD in CME and other training programs.

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Contemporary Incidence and Prevalence of Rheumatic Fever and Rheumatic Heart Disease in Australia Using Linked Data: The Case for Policy Change

Journal of the American Heart Association ◽

10.1161/jaha.120.016851 ◽

2020 ◽

Vol 9 (19) ◽

Cited By ~ 2

Author(s):

Judith M. Katzenellenbogen ◽

Daniela Bond‐Smith ◽

Rebecca J. Seth ◽

Karen Dempsey ◽

Jeffrey Cannon ◽

...

Keyword(s):

Heart Disease ◽

Rheumatic Fever ◽

Rheumatic Heart Disease ◽

Linked Data ◽

Direct Methods ◽

Indigenous Populations ◽

World Health ◽

Indigenous Australians ◽

High Resource ◽

Rheumatic Heart

Background In 2018, the World Health Organization prioritized control of acute rheumatic fever (ARF) and rheumatic heart disease (RHD), including disease surveillance. We developed strategies for estimating contemporary ARF/RHD incidence and prevalence in Australia (2015–2017) by age group, sex, and region for Indigenous and non‐Indigenous Australians based on innovative, direct methods. Methods and Results This population‐based study used linked administrative data from 5 Australian jurisdictions. A cohort of ARF (age <45 years) and RHD cases (<55 years) were sourced from jurisdictional ARF/RHD registers, surgical registries, and inpatient data. We developed robust methods for epidemiologic case ascertainment for ARF/RHD. We calculated age‐specific and age‐standardized incidence and prevalence. Age‐standardized rate and prevalence ratios compared disease burden between demographic subgroups. Of 1425 ARF episodes, 72.1% were first‐ever, 88.8% in Indigenous people and 78.6% were aged <25 years. The age‐standardized ARF first‐ever rates were 71.9 and 0.60/100 000 for Indigenous and non‐Indigenous populations, respectively (age‐standardized rate ratio=124.1; 95% CI, 105.2–146.3). The 2017 Global Burden of Disease RHD prevalent counts for Australia (<55 years) underestimate the burden (1518 versus 6156 Australia‐wide extrapolated from our study). The Indigenous age‐standardized RHD prevalence (666.3/100 000) was 61.4 times higher (95% CI, 59.3–63.5) than non‐Indigenous (10.9/100 000). Female RHD prevalence was double that in males. Regions in northern Australia had the highest rates. Conclusions This study provides the most accurate estimates to date of Australian ARF and RHD rates. The high Indigenous burden necessitates urgent government action. Findings suggest RHD may be underestimated in many high‐resource settings. The linked data methods outlined here have potential for global applicability.

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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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