He VYF

Condon JR

Ralph, Anna

Zhao, Yuejen

Roberts, Kathryn

de Dassel JL

Currie, Bart

Fittock M

Edwards KN

Carapetis JR

2016-07-19

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. 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). ARF recurrence was highest (incidence, 3.7 per 100 person-years) 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. 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.

Circulation . 2016 Jul 19;134(3):222-32. doi: 10.1161/CIRCULATIONAHA.115.020966. Epub 2016 Jul 12.

https://pubmed.ncbi.nlm.nih.gov/27407071/?otool=iaurydwlib

https://hdl.handle.net/10137/5339

alcohol drinking

comorbidity

complications

heart failure

rheumatic heart disease

survival analysis

Acute Disease

Adolescent

Adult

Aged

Alcoholism

Atrial Fibrillation

Child

Child, Preschool

Comorbidity

Disease Progression

Endocarditis

European Continental Ancestry Group

Female

Follow-Up Studies

Heart Failure

Hospitalization

Humans

Infant

Kaplan-Meier Estimate

Male

Middle Aged

Northern Territory

Oceanic Ancestry Group

Proportional Hazards Models

Recurrence

Renal Insufficiency

Rheumatic Fever

Rheumatic Heart Disease

Smoking

Stroke

Treatment Outcome

Young Adult

Long-Term Outcomes From Acute Rheumatic Fever and Rheumatic Heart Disease: A Data-Linkage and Survival Analysis Approach.

Journal Article

Publication