TY - JOUR
T1 - Long-term outcomes from acute rheumatic fever and rheumatic heart disease
AU - He, Vincent
AU - Condon, John
AU - Ralph, Anna
AU - Zhao, Yuejen
AU - Roberts, Kathryn
AU - De Dassel, Jessica Langloh
AU - Currie, Bart
AU - Fittock, Marea Therese
AU - Edwards, Keith
AU - Carapetis, Jonathan
N1 - V.Y.F. He was supported by a University Postgraduate Research Scholarship from Charles Darwin University. Dr Ralph is supported by the National Health and Medical Research Council of Australia (GNT1113638). J.L. de Dassel is supported by an Australian Postgraduate Award scholarship. Dr Zhao, Dr Roberts, Dr Currie, M. Fittock, and Dr Edwards are supported by the NT Department of Health.
PY - 2016
Y1 - 2016
N2 - Background: We investigated adverse outcomes for people with acute
rheumatic fever (ARF) and rheumatic heart disease (RHD) and the effect of
comorbidities and demographic factors on these outcomes.
Methods: Using linked data (RHD register, hospital, and
mortality data) for residents of the Northern Territory of Australia, we
calculated ARF recurrence rates, rates of progression from ARF to RHD to severe
RHD, RHD complication rates (heart failure, endocarditis, stroke, and atrial
fibrillation), and mortality rates for 572 individuals diagnosed with ARF and
1248 with RHD in 1997 to 2013 (94.9% Indigenous).
Results: ARF recurrence was highest (incidence, 3.7 per 100
personyears) in the first year after the initial ARF episode, but low-level
risk persisted for >10 years. Progression to RHD was also highest
(incidence, 35.9) in the first year, almost 10 times higher than ARF
recurrence. The median age at RHD diagnosis in Indigenous people was young,
especially among males (17 years). The development of complications was highest
in the first year after RHD diagnosis: heart failure incidence rate per 100
person-years, 9.09; atrial fibrillation, 4.70; endocarditis, 1.00; and stroke,
0.58. Mortality was higher among Indigenous than non-Indigenous RHD patients
(hazard ratio, 6.55; 95% confidence interval, 2.45–17.51), of which 28% was
explained by comorbid renal failure and hazardous alcohol use. RHD
complications and mortality rates were higher for urban than for remote residents.
Conclusions: This study provides important new prognostic
information for ARF/RHD. The residual Indigenous survival disparity in RHD
patients, which persisted after accounting for comorbidities, suggests that
other factors contribute to mortality, warranting further research.
AB - Background: We investigated adverse outcomes for people with acute
rheumatic fever (ARF) and rheumatic heart disease (RHD) and the effect of
comorbidities and demographic factors on these outcomes.
Methods: Using linked data (RHD register, hospital, and
mortality data) for residents of the Northern Territory of Australia, we
calculated ARF recurrence rates, rates of progression from ARF to RHD to severe
RHD, RHD complication rates (heart failure, endocarditis, stroke, and atrial
fibrillation), and mortality rates for 572 individuals diagnosed with ARF and
1248 with RHD in 1997 to 2013 (94.9% Indigenous).
Results: ARF recurrence was highest (incidence, 3.7 per 100
personyears) in the first year after the initial ARF episode, but low-level
risk persisted for >10 years. Progression to RHD was also highest
(incidence, 35.9) in the first year, almost 10 times higher than ARF
recurrence. The median age at RHD diagnosis in Indigenous people was young,
especially among males (17 years). The development of complications was highest
in the first year after RHD diagnosis: heart failure incidence rate per 100
person-years, 9.09; atrial fibrillation, 4.70; endocarditis, 1.00; and stroke,
0.58. Mortality was higher among Indigenous than non-Indigenous RHD patients
(hazard ratio, 6.55; 95% confidence interval, 2.45–17.51), of which 28% was
explained by comorbid renal failure and hazardous alcohol use. RHD
complications and mortality rates were higher for urban than for remote residents.
Conclusions: This study provides important new prognostic
information for ARF/RHD. The residual Indigenous survival disparity in RHD
patients, which persisted after accounting for comorbidities, suggests that
other factors contribute to mortality, warranting further research.
UR - http://www.scopus.com/inward/record.url?scp=84978715564&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.115.020966
DO - 10.1161/CIRCULATIONAHA.115.020966
M3 - Article
C2 - 27407071
SN - 0009-7322
VL - 134
SP - 222
EP - 232
JO - Circulation
JF - Circulation
IS - 3
ER -
