Aim
Acute rheumatic fever (ARF) is a precursor to rheumatic heart disease (RHD). Many cases of RHD are detected in the absence of ARF history. It is not currently known if ARF at diagnosis influences RHD severity or progression. Our aim was to investigate the link between ARF diagnosis and RHD severity.
Method
The sample included young individuals (5–20 years) from the Northern Territory of Australia with RHD diagnosed between 2012–2021. Echocardiograms were independently reviewed and RHD stage determined using the 2023 World Heart Federation RHD diagnostic guidelines. Findings were compared to the original diagnostic report and where there was discordance, a third observer independently reviewed the images. RHD status at follow-up was compared between individuals with ARF diagnosis and those without.
Results
292 individuals were included: mean age was 11.9 years (SD=3.8 years) and 55.1% were female. 192 (65.8%) were with ARF at the time of RHD diagnosis and 100 (34.2%) without.
There was no difference in the proportions of early RHD (Stage A or Stage B) and advanced RHD (Stage C or D) at baseline (p=0.440) between the groups.
Follow-up data was available for 230 individuals and those with ARF were more likely to change in severity (66.7%) compared to those with no ARF (41.9%, p=0.003, see Figure).
Conclusion
Advanced RHD proportions were similar between those with and those without ARF at diagnosis. Importantly, progression to advanced disease was seen in both groups. A lack of ARF diagnosis should not preclude diagnosis of RHD in individuals from high-risk populations.