Rheumatic Heart Disease Prophylaxis in Older Patients

A Register-Based Audit of Adherence to Guidelines

J. V. Holland, K. Hardie, J. de Dassel, A. P. Ralph

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: Prevention of rheumatic heart disease (RHD) remains challenging in high-burden settings globally. After acute rheumatic fever (ARF), secondary antibiotic prophylaxis is required to prevent RHD. International guidelines on recommended durations of secondary prophylaxis differ, with scope for clinician discretion. Because ARF risk decreases with age, ongoing prophylaxis is generally considered unnecessary beyond approximately the third decade. Concordance with guidelines on timely cessation of prophylaxis is unknown. 

    Methods: We undertook a register-based audit to determine the appropriateness of antibiotic prophylaxis among clients aged >/=35 years in Australia's Northern Territory. Data on demographics, ARF episode(s), RHD severity, prophylaxis type, and relevant clinical notes were extracted. The determination of guideline concordance was based on whether (1) national guidelines were followed; (2) a reason for departure from guidelines was documented; (3) lifelong continuation was considered appropriate in all cases of severe RHD. 

    Results: We identified 343 clients aged >/=35 years prescribed secondary prophylaxis. Guideline concordance was 39% according to national guidelines, 68% when documented reasons for departures from guidelines were included and 82% if patients with severe RHD were deemed to need lifelong prophylaxis. Shorter times since last echocardiogram or cardiologist review were associated with greater likelihood of guideline concordance (P <.001). The median time since last ARF was 5.9 years in the guideline-concordant group and 24.0 years in the non concordant group (P <.001). Thirty-two people had an ARF episode after age 40 years. 

    Conclusions: In this setting, appropriate discontinuation of RHD prophylaxis could be improved through timely specialist review to reduce unnecessary burden on clients and health systems.


    Original languageEnglish
    Pages (from-to)1-7
    Number of pages7
    JournalOpen Forum Infectious Diseases
    Volume5
    Issue number6
    DOIs
    Publication statusPublished - 1 Jun 2018

    Fingerprint

    Guideline Adherence
    Rheumatic Heart Disease
    Guidelines
    Rheumatic Fever
    Antibiotic Prophylaxis
    Northern Territory
    Demography

    Cite this

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    title = "Rheumatic Heart Disease Prophylaxis in Older Patients: A Register-Based Audit of Adherence to Guidelines",
    abstract = "Background: Prevention of rheumatic heart disease (RHD) remains challenging in high-burden settings globally. After acute rheumatic fever (ARF), secondary antibiotic prophylaxis is required to prevent RHD. International guidelines on recommended durations of secondary prophylaxis differ, with scope for clinician discretion. Because ARF risk decreases with age, ongoing prophylaxis is generally considered unnecessary beyond approximately the third decade. Concordance with guidelines on timely cessation of prophylaxis is unknown. Methods: We undertook a register-based audit to determine the appropriateness of antibiotic prophylaxis among clients aged >/=35 years in Australia's Northern Territory. Data on demographics, ARF episode(s), RHD severity, prophylaxis type, and relevant clinical notes were extracted. The determination of guideline concordance was based on whether (1) national guidelines were followed; (2) a reason for departure from guidelines was documented; (3) lifelong continuation was considered appropriate in all cases of severe RHD. Results: We identified 343 clients aged >/=35 years prescribed secondary prophylaxis. Guideline concordance was 39{\%} according to national guidelines, 68{\%} when documented reasons for departures from guidelines were included and 82{\%} if patients with severe RHD were deemed to need lifelong prophylaxis. Shorter times since last echocardiogram or cardiologist review were associated with greater likelihood of guideline concordance (P <.001). The median time since last ARF was 5.9 years in the guideline-concordant group and 24.0 years in the non concordant group (P <.001). Thirty-two people had an ARF episode after age 40 years. Conclusions: In this setting, appropriate discontinuation of RHD prophylaxis could be improved through timely specialist review to reduce unnecessary burden on clients and health systems.",
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    Rheumatic Heart Disease Prophylaxis in Older Patients : A Register-Based Audit of Adherence to Guidelines. / Holland, J. V.; Hardie, K.; de Dassel, J.; Ralph, A. P.

    In: Open Forum Infectious Diseases, Vol. 5, No. 6, 01.06.2018, p. 1-7.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

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    T2 - A Register-Based Audit of Adherence to Guidelines

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    AU - Hardie, K.

    AU - de Dassel, J.

    AU - Ralph, A. P.

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    N2 - Background: Prevention of rheumatic heart disease (RHD) remains challenging in high-burden settings globally. After acute rheumatic fever (ARF), secondary antibiotic prophylaxis is required to prevent RHD. International guidelines on recommended durations of secondary prophylaxis differ, with scope for clinician discretion. Because ARF risk decreases with age, ongoing prophylaxis is generally considered unnecessary beyond approximately the third decade. Concordance with guidelines on timely cessation of prophylaxis is unknown. Methods: We undertook a register-based audit to determine the appropriateness of antibiotic prophylaxis among clients aged >/=35 years in Australia's Northern Territory. Data on demographics, ARF episode(s), RHD severity, prophylaxis type, and relevant clinical notes were extracted. The determination of guideline concordance was based on whether (1) national guidelines were followed; (2) a reason for departure from guidelines was documented; (3) lifelong continuation was considered appropriate in all cases of severe RHD. Results: We identified 343 clients aged >/=35 years prescribed secondary prophylaxis. Guideline concordance was 39% according to national guidelines, 68% when documented reasons for departures from guidelines were included and 82% if patients with severe RHD were deemed to need lifelong prophylaxis. Shorter times since last echocardiogram or cardiologist review were associated with greater likelihood of guideline concordance (P <.001). The median time since last ARF was 5.9 years in the guideline-concordant group and 24.0 years in the non concordant group (P <.001). Thirty-two people had an ARF episode after age 40 years. Conclusions: In this setting, appropriate discontinuation of RHD prophylaxis could be improved through timely specialist review to reduce unnecessary burden on clients and health systems.

    AB - Background: Prevention of rheumatic heart disease (RHD) remains challenging in high-burden settings globally. After acute rheumatic fever (ARF), secondary antibiotic prophylaxis is required to prevent RHD. International guidelines on recommended durations of secondary prophylaxis differ, with scope for clinician discretion. Because ARF risk decreases with age, ongoing prophylaxis is generally considered unnecessary beyond approximately the third decade. Concordance with guidelines on timely cessation of prophylaxis is unknown. Methods: We undertook a register-based audit to determine the appropriateness of antibiotic prophylaxis among clients aged >/=35 years in Australia's Northern Territory. Data on demographics, ARF episode(s), RHD severity, prophylaxis type, and relevant clinical notes were extracted. The determination of guideline concordance was based on whether (1) national guidelines were followed; (2) a reason for departure from guidelines was documented; (3) lifelong continuation was considered appropriate in all cases of severe RHD. Results: We identified 343 clients aged >/=35 years prescribed secondary prophylaxis. Guideline concordance was 39% according to national guidelines, 68% when documented reasons for departures from guidelines were included and 82% if patients with severe RHD were deemed to need lifelong prophylaxis. Shorter times since last echocardiogram or cardiologist review were associated with greater likelihood of guideline concordance (P <.001). The median time since last ARF was 5.9 years in the guideline-concordant group and 24.0 years in the non concordant group (P <.001). Thirty-two people had an ARF episode after age 40 years. Conclusions: In this setting, appropriate discontinuation of RHD prophylaxis could be improved through timely specialist review to reduce unnecessary burden on clients and health systems.

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