Long-term outcomes from acute rheumatic fever and rheumatic heart disease

Vincent He, John Condon, Anna Ralph, Yuejen Zhao, Kathryn Roberts, Jessica Langloh De Dassel, Bart Currie, Marea Therese Fittock, Keith Edwards, Jonathan Carapetis

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    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.

    Original languageEnglish
    Pages (from-to)222-232
    Number of pages11
    JournalCirculation
    Volume134
    Issue number3
    DOIs
    Publication statusPublished - 2016

    Fingerprint

    Rheumatic Heart Disease
    Rheumatic Fever
    Fever
    Mortality
    Endocarditis
    Incidence
    Heart Failure
    Stroke
    Northern Territory
    Recurrence
    Atrial Fibrillation
    Renal Insufficiency
    Comorbidity
    Alcohols
    Demography
    Confidence Intervals

    Cite this

    He, Vincent ; Condon, John ; Ralph, Anna ; Zhao, Yuejen ; Roberts, Kathryn ; De Dassel, Jessica Langloh ; Currie, Bart ; Fittock, Marea Therese ; Edwards, Keith ; Carapetis, Jonathan. / Long-term outcomes from acute rheumatic fever and rheumatic heart disease. In: Circulation. 2016 ; Vol. 134, No. 3. pp. 222-232.
    @article{72faa28bba664fd1b7ed8061fc5f27e9,
    title = "Long-term outcomes from acute rheumatic fever and rheumatic heart disease",
    abstract = "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.",
    author = "Vincent He and John Condon and Anna Ralph and Yuejen Zhao and Kathryn Roberts and {De Dassel}, {Jessica Langloh} and Bart Currie and Fittock, {Marea Therese} and Keith Edwards and Jonathan Carapetis",
    note = "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.",
    year = "2016",
    doi = "10.1161/CIRCULATIONAHA.115.020966",
    language = "English",
    volume = "134",
    pages = "222--232",
    journal = "Circulation",
    issn = "0009-7322",
    publisher = "Lippincott Williams & Wilkins",
    number = "3",

    }

    He, V, Condon, J, Ralph, A, Zhao, Y, Roberts, K, De Dassel, JL, Currie, B, Fittock, MT, Edwards, K & Carapetis, J 2016, 'Long-term outcomes from acute rheumatic fever and rheumatic heart disease', Circulation, vol. 134, no. 3, pp. 222-232. https://doi.org/10.1161/CIRCULATIONAHA.115.020966

    Long-term outcomes from acute rheumatic fever and rheumatic heart disease. / He, Vincent; Condon, John; Ralph, Anna; Zhao, Yuejen; Roberts, Kathryn; De Dassel, Jessica Langloh; Currie, Bart; Fittock, Marea Therese; Edwards, Keith; Carapetis, Jonathan.

    In: Circulation, Vol. 134, No. 3, 2016, p. 222-232.

    Research output: Contribution to journalArticleResearchpeer-review

    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

    VL - 134

    SP - 222

    EP - 232

    JO - Circulation

    JF - Circulation

    SN - 0009-7322

    IS - 3

    ER -