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

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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.
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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.",
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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.

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U2 - 10.1161/CIRCULATIONAHA.115.020966

DO - 10.1161/CIRCULATIONAHA.115.020966

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