Abstract
Objective: Rheumatic heart disease (RHD) comprises heart-valve damage caused by acute rheumatic fever (ARF). The Australian Government Rheumatic Fever Strategy funds RHD Control Programs to support detection and management of ARF and RHD. We assessed epidemiological changes during the years of RHD Control Program operation. Methods: Linked RHD register, hospital and death data from four Australian jurisdictions were used to measure ARF/RHD outcomes between 2010 and 2017, including: 2-year progression to severe RHD/death; ARF recurrence; secondary prophylaxis delivery and earlier disease detection. Results: Delivery of secondary prophylaxis improved from 53% median proportion of days covered (95%CI: 46-61%, 2010) to 70% (95%CI: 71-68%, 2017). Secondary prophylaxis adherence protected against progression to severe RHD/death (hazard ratio 0.2, 95% CI 0.1-0.8). Other measures of program effectiveness (ARF recurrences, progression to severe RHD/death) remained stable. ARF case numbers and concurrent ARF/RHD diagnoses increased. Conclusions: RHD Control Programs have contributed to major success in the management of ARF/RHD through increased delivery of secondary prevention yet ARF case numbers, not impacted by secondary prophylaxis and sensitive to increased awareness/surveillance, increased. Implications for public health: RHD Control Programs have a major role in delivering cost-effective RHD prevention. Sustained investment is needed but with greatly strengthened primordial and primary prevention.
| Original language | English |
|---|---|
| Article number | 100071 |
| Pages (from-to) | 1-9 |
| Number of pages | 9 |
| Journal | Australian and New Zealand Journal of Public Health |
| Volume | 47 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Aug 2023 |
Bibliographical note
Funding Information:The authors acknowledge that figures and other statistics represent the loss of health and human life with profound impact and sadness for people, families, community, and culture. These numbers also obscure the resilience and strengths of the people involved. We hope that the “numbers story” emanating from this project can augment the “lived stories” that reflect the voices of people with RHD and their families. The authors value the support/endorsement provided to the project by the following peak bodies representing the Aboriginal Community Controlled Health sector: Aboriginal Medical Services Alliance Northern Territory, Kimberley Aboriginal Medical Service (the health service serving the high-burden region of WA), Aboriginal Health Council of South Australia, and Aboriginal Health and Medical Research Council (NSW). We also received support from the Aboriginal divisions of Queensland and WA Health Departments. We are committed to providing feedback to these organizations ensuring that the findings are accessible and provide the evidence needed for policy that can reduce the burden of ARF and RHD in Australia. The authors also thank the staff of the data linkage units of the State and Territory governments (WA, SA-NT, NSW, Queensland) for linkage of the ERASE project data. We thank the State and Territory Registries of Births, Deaths and Marriages, the State and Territory Coroners, and the National Coronial Information System and Victorian Department of Justice for enabling Cause of Death Unit Record File data to be used for this project. Further, we thank the data custodians and data managers for the provision of the following data. Inpatient hospital and Emergency Department data (5 States and Territories), RHD registers (5 States and Territories), The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database (single registry covering 5 States and Territories), Royal Melbourne Children’s Hospital Paediatric Cardiac Surgery database (single data source for RHD pediatric patients from SA and NT receiving surgical intervention in Melbourne), Primary health care data from NT Department of Health. This work was supported by funding from the National Health and Medical Research Council (NHMRC) through project grant (#114652) and seed funds from the End -RHD Centre for Research Excellence and HeartKids. Ingrid Stacey is supported by an NHMRC Postgraduate Scholarship Grant (#2005398) and an Ad Hoc Postgraduate Scholarship from The University of Western Australia. Judith Katzenellenbogen and Lee Nedkoff are supported by National Heart Foundation of Australia Future Leader Fellowships (#102043, 105038).
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