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Govender K, Müller A. Secondary Prophylaxis Among First Nations People With Acute Rheumatic Fever in Australia: An Integrative Review. J Transcult Nurs 2023; 34:443-452. [PMID: 37572036 PMCID: PMC10637076 DOI: 10.1177/10436596231191248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023] Open
Abstract
INTRODUCTION The prevalence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) among Australia's First Nations populations are some of the highest in the world, accounting for 95% of the 2,244 ARF notifications between 2015 and 2019 in Australia. A key issue in treating ARF is long-term secondary prophylaxis, yet only one in five patients received treatment in 2019. This review identifies barriers to secondary prophylaxis of ARF in Australia's First Nations people. METHODS An integrative review was undertaken utilizing PubMed, CINAHL, ProQuest, and Wiley Online. Joanna Briggs Institute critical appraisal tools were used, followed by thematic analysis. RESULTS The key themes uncovered included: issues with database and recall systems, patient/family characteristics, service delivery location and site, pain of injection, education (including language barriers), and patient-clinician relationship. CONCLUSIONS A national RHD register, change in operation model, improved pain management, improved education, and need for consistent personnel is suggested.
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Affiliation(s)
| | - Amanda Müller
- Flinders University, Adelaide, South Australia, Australia
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2
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The Spectrum, Severity and Outcomes of Rheumatic Mitral Valve Disease in Pregnant Women in Australia and New Zealand. Heart Lung Circ 2021; 31:480-490. [PMID: 34840063 DOI: 10.1016/j.hlc.2021.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 08/16/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Rheumatic heart disease (RHD) poses significant perinatal risks. We aimed to describe the spectrum, severity and outcomes of rheumatic mitral valve disease in pregnancy in Australia and New Zealand. METHODS A prospective, population-based cohort study of pregnant women with RHD recruited 2013-14 through the hospital-based Australasian Maternity Outcomes Surveillance System. Outcome measures included maternal and perinatal morbidity and mortality. Univariable and multivariable logistic regression analyses were undertaken to test for predictors of adverse maternal and perinatal outcomes. RESULTS Of 274 pregnant women identified with RHD, 124 (45.3%) had mitral stenosis (MS) and 150 (54.7%) had isolated mitral regurgitation (MR). One woman with mild MS/moderate MR died. There were six (2.2%) stillbirths and two (0.7%) neonatal deaths. Babies born to women with MS were twice as likely to be small-for-gestational-age (22.7% vs 11.4%, p=0.013). In women with MS, use of cardiac medication (AOR 7.42) and having severe stenosis (AOR 16.35) were independently associated with adverse cardiac outcomes, while NYHA class >1 (AOR 3.94) was an independent predictor of adverse perinatal events. In women with isolated MR, use of cardiac medications (AOR 7.03) and use of anticoagulants (AOR 6.05) were independently associated with adverse cardiac outcomes. CONCLUSIONS Careful monitoring and specialist care for women with RHD in pregnancy is required, particularly for women with severe MS, those on cardiac medication, and those on anticoagulation, as these are associated with increased risk of adverse maternal cardiac outcomes. In the context of pregnancy, contraception and preconception planning are important for young women diagnosed with RHD.
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Kevat PM, Gunnarsson R, Reeves BM, Ruben AR. Adherence rates and risk factors for suboptimal adherence to secondary prophylaxis for rheumatic fever. J Paediatr Child Health 2021; 57:419-424. [PMID: 33340191 PMCID: PMC8048926 DOI: 10.1111/jpc.15239] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/19/2020] [Accepted: 10/06/2020] [Indexed: 11/28/2022]
Abstract
AIM Secondary prophylaxis with 3-4 weekly benzathine penicillin G injections is necessary to prevent disease morbidity and cardiac mortality in patients with acute rheumatic fever (ARF) and rheumatic heart disease (RHD). This study aimed to determine secondary prophylaxis adherence rates in the Far North Queensland paediatric population and to identify factors contributing to suboptimal adherence. METHODS A retrospective analysis of data recorded in the online RHD register for Queensland, Australia, was performed for a 10-year study period. The proportion of benzathine penicillin G injections delivered within intervals of ≤28 days and ≤35 days was measured. A multi-level mixed model logistic regression assessed the influence of age, gender, ethnicity, suburb, Accessibility and Remoteness Index of Australia class, number of people per dwelling, Index of Relative Socio-economic Advantage and Disadvantage, Index of Education and Occupation, year of inclusion on an ARF/RHD register and individual effect. RESULTS The study included 277 children and analysis of 7374 injections. No children received ≥80% of recommended injections within a 28-day interval. Four percent received ≥50% of injections within ≤28 days and 46% received ≥50% of injections at an extended interval of ≤35 days. Increasing age was associated with reduced delivery of injections within 35 days. Increasing year of inclusion was associated with improved delivery within 28 days. The random effect of individual patients was significantly associated with adherence. CONCLUSIONS Improved timely delivery of secondary prophylaxis for ARF and RHD is needed as current adherence is very low. Interventions should focus on factors specific to each individual child or family unit.
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Affiliation(s)
- Priya M Kevat
- College of Medicine and DentistryJames Cook UniversityCairnsQueenslandAustralia
- Clinical ServicesApunipima Cape York Health CouncilCairnsQueenslandAustralia
- Department of PaediatricsCairns and Hinterland Hospital and Health ServiceCairnsQueenslandAustralia
- The Royal Children's HospitalMelbourneVictoriaAustralia
| | - Ronny Gunnarsson
- College of Medicine and DentistryJames Cook UniversityCairnsQueenslandAustralia
- Research, Development, Education and InnovationPrimary Health CareGothenburgRegion Västra GötalandSweden
- General Practice/Family Medicine, Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Benjamin M Reeves
- Department of PaediatricsCairns and Hinterland Hospital and Health ServiceCairnsQueenslandAustralia
| | - Alan R Ruben
- Clinical ServicesApunipima Cape York Health CouncilCairnsQueenslandAustralia
- Medical Services, Torres and Cape Hospital and Health ServiceCairnsQueenslandAustralia
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Kang K, Chau KWT, Howell E, Anderson M, Smith S, Davis TJ, Starmer G, Hanson J. The temporospatial epidemiology of rheumatic heart disease in Far North Queensland, tropical Australia 1997-2017; impact of socioeconomic status on disease burden, severity and access to care. PLoS Negl Trop Dis 2021; 15:e0008990. [PMID: 33444355 PMCID: PMC7840049 DOI: 10.1371/journal.pntd.0008990] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/27/2021] [Accepted: 11/16/2020] [Indexed: 11/21/2022] Open
Abstract
Background The incidence of rheumatic heart disease (RHD) among Indigenous Australians remains one of the highest in the world. Many studies have highlighted the relationship between the social determinants of health and RHD, but few have used registry data to link socioeconomic disadvantage to the delivery of patient care and long-term outcomes. Methods A retrospective study of individuals living with RHD in Far North Queensland (FNQ), Australia between 1997 and 2017. Patients were identified using the Queensland state RHD register. The Socio-Economic Indexes for Areas (SEIFA) Score–a measure of socioeconomic disadvantage–was correlated with RHD prevalence, disease severity and measures of RHD care. Results Of the 686 individuals, 622 (90.7%) were Indigenous Australians. RHD incidence increased in the region from 4.7/100,000/year in 1997 to 49.4/100,000/year in 2017 (p<0.001). In 2017, the prevalence of RHD was 12/1000 in the Indigenous population and 2/1000 in the non-Indigenous population (p<0.001). There was an inverse correlation between an area’s SEIFA score and its RHD prevalence (rho = -0.77, p = 0.005). 249 (36.2%) individuals in the cohort had 593 RHD-related hospitalisations; the number of RHD-related hospitalisations increased during the study period (p<0.001). In 2017, 293 (42.7%) patients met criteria for secondary prophylaxis, but only 73 (24.9%) had good adherence. Overall, 119/686 (17.3%) required valve surgery; the number of individuals having surgery increased over the study period (p = 0.02). During the study 39/686 (5.7%) died. Non-Indigenous patients were more likely to die than Indigenous patients (9/64 (14%) versus 30/622 (5%), p = 0.002), but Indigenous patients died at a younger age (median (IQR): 52 (35–67) versus 73 (62–77) p = 0.013). RHD-related deaths occurred at a younger age in Indigenous individuals than non-Indigenous individuals (median (IQR) age: 29 (12–58) versus 77 (64–78), p = 0.007). Conclusions The incidence of RHD, RHD-related hospitalisations and RHD-related surgery continues to rise in FNQ. Whilst this is partly explained by increased disease recognition and improved delivery of care, the burden of RHD remains unacceptably high and is disproportionately borne by the socioeconomically disadvantaged Indigenous population. Rheumatic heart disease (RHD), a disease of poverty and disadvantage, is almost completely preventable. It is now extremely rare in wealthy countries, but in Far North Queensland in tropical Australia, the incidence of RHD, RHD-related hospitalisations and RHD-related surgery is continuing to rise, with the burden of disease borne almost entirely by the region’s Indigenous population. While the increasing incidence of RHD and its complications may be partly explained by improvements in local service delivery, the disease remains inextricably linked to socioeconomic disadvantage. In this study, not only were patients living in socioeconomically disadvantaged areas more likely to have RHD, but they were also paradoxically less likely to receive valve surgery. The current local model of care—which is centralised, medical and emphasises disease monitoring and secondary prophylaxis—appears to be having a limited impact on morbidity. Strategies must evolve—in partnership with Indigenous communities—to have a greater focus on disease prevention by addressing the personal, community and environmental factors that increase the risk of the disease. This is likely to not only reduce the incidence of RHD, but will also tend to reduce the burden of the many other diseases that result from socioeconomic disadvantage and that disproportionately affect Indigenous Australians.
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Affiliation(s)
- Katherine Kang
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Ken W. T. Chau
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Erin Howell
- Rheumatic Heart Disease Program, Tropical Public Health Unit, Cairns, Queensland, Australia
| | - Mellise Anderson
- Rheumatic Heart Disease Program, Tropical Public Health Unit, Cairns, Queensland, Australia
| | - Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Tania J. Davis
- Department of Cardiology, Cairns Hospital, Cairns, Queensland, Australia
| | - Greg Starmer
- Department of Cardiology, Cairns Hospital, Cairns, Queensland, Australia
| | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- * E-mail:
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Wyber R, Noonan K, Halkon C, Enkel S, Cannon J, Haynes E, Mitchell AG, Bessarab DC, Katzenellenbogen JM, Bond-Smith D, Seth R, D'Antoine H, Ralph AP, Bowen AC, Brown A, Carapetis JR. Ending rheumatic heart disease in Australia: the evidence for a new approach. Med J Aust 2020; 213 Suppl 10:S3-S31. [PMID: 33190287 DOI: 10.5694/mja2.50853] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
■The RHD Endgame Strategy: the blueprint to eliminate rheumatic heart disease in Australia by 2031 (the Endgame Strategy) is the blueprint to eliminate rheumatic heart disease (RHD) in Australia by 2031. Aboriginal and Torres Strait Islander people live with one of the highest per capita burdens of RHD in the world. ■The Endgame Strategy synthesises information compiled across the 5-year lifespan of the End Rheumatic Heart Disease Centre of Research Excellence (END RHD CRE). Data and results from priority research projects across several disciplines of research complemented literature reviews, systematic reviews and narrative reviews. Further, the experiences of those working in acute rheumatic fever (ARF) and RHD control and those living with RHD to provide the technical evidence for eliminating RHD in Australia were included. ■The lived experience of RHD is a critical factor in health outcomes. All future strategies to address ARF and RHD must prioritise Aboriginal and Torres Strait Islander people's knowledge, perspectives and experiences and develop co-designed approaches to RHD elimination. The environmental, economic, social and political context of RHD in Australia is inexorably linked to ending the disease. ■Statistical modelling undertaken in 2019 looked at the economic and health impacts of implementing an indicative strategy to eliminate RHD by 2031. Beginning in 2019, the strategy would include: reducing household crowding, improving hygiene infrastructure, strengthening primary health care and improving secondary prophylaxis. It was estimated that the strategy would prevent 663 deaths and save the health care system $188 million. ■The Endgame Strategy provides the evidence for a new approach to RHD elimination. It proposes an implementation framework of five priority action areas. These focus on strategies to prevent new cases of ARF and RHD early in the causal pathway from Streptococcus pyogenes exposure to ARF, and strategies that address the critical systems and structural changes needed to support a comprehensive RHD elimination strategy.
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Affiliation(s)
- Rosemary Wyber
- George Institute for Global Health, Sydney, NSW.,Telethon Kids Institute, Perth, WA
| | | | | | | | | | | | | | | | | | | | - Rebecca Seth
- Telethon Kids Institute, Perth, WA.,University of Western Australia, Perth, WA
| | | | | | - Asha C Bowen
- Telethon Kids Institute, Perth, WA.,Perth Children's Hospital, Perth, WA
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, SA.,University of South Australia, Adelaide, SA
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Dooley LM, Ahmad TB, Pandey M, Good MF, Kotiw M. Rheumatic heart disease: A review of the current status of global research activity. Autoimmun Rev 2020; 20:102740. [PMID: 33333234 DOI: 10.1016/j.autrev.2020.102740] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/04/2020] [Indexed: 01/17/2023]
Abstract
Rheumatic heart disease (RHD) is a serious and long-term consequence of acute rheumatic fever (ARF), an autoimmune sequela of a mucosal infection by Streptococcus pyogenes (Group A Streptococcus, Strep A). The pathogenesis of ARF and RHD is complex and not fully understood but involves host and bacterial factors, molecular mimicry, and aberrant host innate and adaptive immune responses that result in loss of self-tolerance and subsequent cross-reactivity with host tissues. RHD is entirely preventable yet claims an estimated 320 000 lives annually. The major burden of disease is carried by developing nations and Indigenous populations within developed nations, including Australia. This review will focus on the epidemiology, pathogenesis and treatment of ARF and RHD in Australia, where: streptococcal pyoderma, rather than streptococcal pharyngitis, and Group C and Group G Streptococcus, have been implicated as antecedents to ARF; the rates of RHD in remote Indigenous communities are persistently among the highest in the world; government register-based programs coordinate disease screening and delivery of prophylaxis with variable success; and researchers are making significant progress in the development of a broad-spectrum vaccine against Strep A.
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Affiliation(s)
- Leanne M Dooley
- School of Health and Wellbeing, University of Southern Queensland, Toowoomba, Queensland, Australia; Institute for Life Sciences and the Environment, University of Southern Queensland, Toowoomba, Queensland, Australia.
| | - Tarek B Ahmad
- School of Health and Wellbeing, University of Southern Queensland, Toowoomba, Queensland, Australia; Institute for Life Sciences and the Environment, University of Southern Queensland, Toowoomba, Queensland, Australia.
| | - Manisha Pandey
- The Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia.
| | - Michael F Good
- The Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia.
| | - Michael Kotiw
- School of Health and Wellbeing, University of Southern Queensland, Toowoomba, Queensland, Australia; Institute for Life Sciences and the Environment, University of Southern Queensland, Toowoomba, Queensland, Australia.
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7
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Woods JA, Katzenellenbogen JM. Adherence to Secondary Prophylaxis Among Patients with Acute Rheumatic Fever and Rheumatic Heart Disease. Curr Cardiol Rev 2019; 15:239-241. [PMID: 31084592 PMCID: PMC6719386 DOI: 10.2174/1573403x1503190506120953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- John A Woods
- Western Australian Centre for Rural Health, School of Population and Global Health, The University of Western Australia, Crawley, WA 6009, Australia
| | - Judith M Katzenellenbogen
- School of Population and Global Health, The University of Western Australia, Crawley, WA 6009, Australia.,Telethon Kids Institute, The University of Western Australia, Crawley, WA 6009, Australia
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9
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Haran S, Crane N, Kazi S, Axford-Haines L, White A. Effect of secondary penicillin prophylaxis on valvular changes in patients with rheumatic heart disease in Far North Queensland. Aust J Rural Health 2017; 26:119-125. [PMID: 29168587 DOI: 10.1111/ajr.12379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine the effect of secondary penicillin prophylaxis on echocardiographic diagnosed valvular changes in patients with rheumatic heart disease or history of acute rheumatic fever in the Townsville Health district. DESIGN Patients with known were identified from the North Queensland register, serial echocardiogram results and number of secondary penicillin prophylaxis doses received in 2014 were collated. Descriptive statistics were utilised. SETTING Townsville Hospital and outreach clinics within the Townsville Health catchment zone. PARTICIPANTS All patients diagnosed with acute rheumatic fever or rheumatic heart disease between 2010 and October 2013 who had serial echocardiograms prior to and post commencement of secondary penicillin prophylaxis were included. All patients were of Aboriginal or Torres Strait Islander descent. MAIN OUTCOME MEASURE Progression of echocardiographic valvular changes and association with secondary penicillin prophylaxis compliance. Compliance with secondary penicillin prophylaxis among the study population was a secondary outcome measure. RESULTS Twenty-three patients were recruited. Only those patients who were compliant with secondary penicillin prophylaxis had any improvement in valvular changes on echocardiogram. Four of six patients without any baseline valvular involvement developed new valvular changes. Seventy percent of patients received >75% of secondary penicillin prophylaxis doses. CONCLUSIONS This small study of patients in Townsville suggests that with good secondary penicillin prophylaxis compliance there is regression of some cardiac lesions over time in people with rheumatic heart disease. Furthermore the natural history of acute rheumatic fever in the Indigenous population is progressive requiring strict adherence to secondary penicillin prophylaxis. Prospective studies or use of data from the nationwide RHD register and standardised reporting of cardiac echocardiograms will provide more robust evidence.
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Affiliation(s)
- Shankar Haran
- Townsville Hospital, Townsville, Queensland, Australia
| | - Natalie Crane
- Townsville Hospital, Townsville, Queensland, Australia
| | - Saniya Kazi
- Townsville Hospital, Townsville, Queensland, Australia
| | - Louise Axford-Haines
- Townsville and Mackay Hospital and Health Service Rheumatic Heart Disease Registry, Townsville, Queensland, Australia
| | - Andrew White
- Townsville Hospital, Townsville, Queensland, Australia
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Cannon J, Roberts K, Milne C, Carapetis JR. Rheumatic Heart Disease Severity, Progression and Outcomes: A Multi-State Model. J Am Heart Assoc 2017; 6:JAHA.116.003498. [PMID: 28255075 PMCID: PMC5523987 DOI: 10.1161/jaha.116.003498] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Rheumatic heart disease (RHD) remains a disease of international importance, yet little has been published about disease progression in a contemporary patient cohort. Multi‐state models provide a well‐established method of estimating rates of transition between disease states, and can be used to evaluate the cost‐effectiveness of potential interventions. We aimed to create a multi‐state model for RHD progression using serial clinical data from a cohort of Australian patients. Methods and Results The Northern Territory RHD register was used to identify all Indigenous residents diagnosed with RHD between the ages of 5 and 24 years in the time period 1999–2012. Disease severity over time, surgeries, and deaths were evaluated for 591 patients. Of 96 (16.2%) patients with severe RHD at diagnosis, 50% had proceeded to valve surgery by 2 years, and 10% were dead within 6 years. Of those diagnosed with moderate RHD, there was a similar chance of disease regression or progression over time. Patients with mild RHD at diagnosis were the most stable, with 64% remaining mild after 10 years; however, 11.4% progressed to severe RHD and half of these required surgery. Conclusions The prognosis of young Indigenous Australians diagnosed with severe RHD is bleak; interventions must focus on earlier detection and treatment if the observed natural history is to be improved. This multi‐state model can be used to predict the effect of different interventions on disease progression and the associated costs.
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Affiliation(s)
- Jeffrey Cannon
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Kathryn Roberts
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia
| | - Catherine Milne
- NT Rheumatic Heart Disease Register, Centre for Disease Control, Darwin, Northern Territory, Australia
| | - Jonathan R Carapetis
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
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Kevat PM, Reeves BM, Ruben AR, Gunnarsson R. Adherence to Secondary Prophylaxis for Acute Rheumatic Fever and Rheumatic Heart Disease: A Systematic Review. Curr Cardiol Rev 2017; 13:155-166. [PMID: 28093988 PMCID: PMC5452151 DOI: 10.2174/1573403x13666170116120828] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 10/05/2016] [Accepted: 10/07/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Optimal delivery of regular benzathine penicillin G (BPG) injections prescribed as secondary prophylaxis for acute rheumatic fever (ARF) and rheumatic heart disease (RHD) is vital to preventing disease morbidity and cardiac sequelae in affected pediatric and young adult populations. However, poor uptake of secondary prophylaxis remains a significant challenge to ARF/RHD control programs. OBJECTIVE In order to facilitate better understanding of this challenge and thereby identify means to improve service delivery, this systematic literature review explored rates of adherence and factors associated with adherence to secondary prophylaxis for ARF and RHD worldwide. METHODS MEDLINE was searched for relevant primary studies published in the English language from 1994-2014, and a search of reference lists of eligible articles was performed. The methodological quality of included studies was evaluated using a modified assessment tool. RESULTS Twenty studies were included in the review. There was a range of adherence to varying regimens of secondary prophylaxis reported globally, and a number of patient demographic, clinical, socio-cultural and health care service delivery factors associated with adherence to secondary prophylaxis were identified. CONCLUSION Insights into factors associated with lower and higher adherence to secondary prophylaxis may be utilized to facilitate improved delivery of secondary prophylaxis for ARF and RHD. Strategies may include ensuring an effective active recall system, providing holistic care, involving community health workers and delivering ARF/RHD health education.
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Affiliation(s)
- Priya M Kevat
- Royal Children's Hospital, Melbourne, Victoria, Australia.,College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Benjamin M Reeves
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.,Department of Paediatrics, Cairns Base Hospital, Cairns, Queensland, Australia
| | - Alan R Ruben
- Apunipima Cape York Health Council and Torres and Cape Hospital and Health Service, Queensland, Australia
| | - Ronny Gunnarsson
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.,Research and development unit, Primary health care and dental care, Southern Älvsborg county, Region Västra Götaland, Sweden.,Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden
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Abstract
Rheumatic heart disease (RHD) is a disease of poverty, is almost entirely preventable, and is the most common cardiovascular disease worldwide in those under 25 years. RHD is caused by acute rheumatic fever (ARF) which typically results in cumulative valvular lesions that may present clinically after a number of years of subclinical disease. Therapeutic interventions, therefore, typically focus on preventing subsequent ARF episodes (with penicillin prophylaxis). However, not all patients with ARF develop symptoms and not all symptomatic cases present to a physician or are correctly diagnosed. Therefore, if we hope to control ARF and RHD at the population level, we need a more reliable discriminator of subclinical disease. Recent studies have examined the utility of echocardiographic screening, which is far superior to auscultation at detecting RHD. However, there are many concerns surrounding this approach. Despite the introduction of the World Heart Federation diagnostic criteria in 2012, we still do not really know what constitutes the most subtle changes of RHD by echocardiography. This poses serious problems regarding whom to treat and what to do with the rest, both important decisions with widespread implications for already stretched health-care systems. In addition, issues ranging from improving the uptake of penicillin prophylaxis in ARF/RHD-positive patients, improving portable echocardiographic equipment, understanding the natural history of subclinical RHD and how it might respond to penicillin, and developing simplified diagnostic criteria that can be applied by nonexperts, all need to be effectively tackled before routine widespread screening for RHD can be endorsed.
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Affiliation(s)
- Scott Dougherty
- Department of Internal Medicine, Ministry of Health, Belau National Hospital, Koror, Republic of Palau
| | - Maziar Khorsandi
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Philip Herbst
- Division of Cardiology, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa
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Engelman D, Mataika RL, Kado JH, Ah Kee M, Donath S, Parks T, Steer AC. Adherence to secondary antibiotic prophylaxis for patients with rheumatic heart disease diagnosed through screening in Fiji. Trop Med Int Health 2016; 21:1583-1591. [PMID: 27730711 DOI: 10.1111/tmi.12796] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Echocardiographic screening for rheumatic heart disease (RHD) can detect subclinical cases; however, adequate adherence to secondary antibiotic prophylaxis (SAP) is required to alter disease outcomes. We aimed to investigate the adherence to SAP among young people with RHD diagnosed through echocardiographic screening in Fiji and to investigate factors associated with adherence. METHODS Patients diagnosed with RHD through echocardiographic screening in Fiji from 2006 to 2014 were included. Dates of benzathine penicillin G injections were collected from 76 health clinics nationally from December 2011 to December 2014. Adherence was measured using the proportion of days covered (PDC). Multivariate logistic regression analysis was used to identify characteristics associated with any adherence (≥1 injection received) and adequate adherence (PDC ≥0.80). RESULTS Of 494 patients, 268 (54%) were female and the median age was 14 years. Overall, 203 (41%) had no injections recorded and just 33 (7%) had adequate adherence. Multivariate logistic regression showed increasing age (OR 0.93 per year, 95% CI 0.87-0.99) and time since diagnosis ≥1.5 years (OR 0.53, 95% CI 0.37-0.79) to be inversely associated with any adherence. Non-iTaukei ethnicity (OR 2.58, 95%CI 1.04-6.33) and urban residence (OR 3.36, 95% CI 1.54-7.36) were associated with adequate adherence, whereas time since diagnosis ≥1.5 years (OR 0.38, 95%CI 0.17-0.83) was inversely associated with adequate adherence. CONCLUSIONS Adherence to SAP after screening in Fiji is currently inadequate for individual patient protection or population disease control. Secondary prevention should be strengthened before further screening can be justified.
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Affiliation(s)
- Daniel Engelman
- Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia.,Murdoch Childrens Research Institute, Parkville, Vic, Australia.,Royal Children's Hospital, Parkville, Vic, Australia
| | - Reapi L Mataika
- Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji
| | - Joseph H Kado
- Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji.,College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.,Fiji Rheumatic Heart Disease Control Program, Suva, Fiji
| | - Maureen Ah Kee
- Fiji Rheumatic Heart Disease Control Program, Suva, Fiji
| | - Susan Donath
- Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia.,Murdoch Childrens Research Institute, Parkville, Vic, Australia
| | - Tom Parks
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Andrew C Steer
- Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia.,Murdoch Childrens Research Institute, Parkville, Vic, Australia.,Royal Children's Hospital, Parkville, Vic, Australia
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Chamberlain-Salaun J, Mills J, Kevat PM, Rémond MGW, Maguire GP. Sharing success - understanding barriers and enablers to secondary prophylaxis delivery for rheumatic fever and rheumatic heart disease. BMC Cardiovasc Disord 2016; 16:166. [PMID: 27581750 PMCID: PMC5007824 DOI: 10.1186/s12872-016-0344-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/11/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Rheumatic fever (RF) and rheumatic heart disease (RHD) cause considerable morbidity and mortality amongst Australian Aboriginal and Torres Strait Islander populations. Secondary antibiotic prophylaxis in the form of 4-weekly benzathine penicillin injections is the mainstay of control programs. Evidence suggests, however, that delivery rates of such prophylaxis are poor. METHODS This qualitative study used semi-structured interviews with patients, parents/care givers and health professionals, to explore the enablers of and barriers to the uptake of secondary prophylaxis. Data from participant interviews (with 11 patients/carers and 11 health practitioners) conducted in four far north Queensland sites were analyzed using the method of constant comparative analysis. RESULTS Deficits in registration and recall systems and pain attributed to injections were identified as barriers to secondary prophylaxis uptake. There were also varying perceptions regarding responsibility for ensuring injection delivery. Enablers of secondary prophylaxis uptake included positive patient-healthcare provider relationships, supporting patient autonomy, education of patients, care givers and healthcare providers, and community-based service delivery. CONCLUSION The study findings provide insights that may facilitate enhancement of secondary prophylaxis delivery systems and thereby improve uptake of secondary prophylaxis for RF/RHD.
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Affiliation(s)
| | - Jane Mills
- School of Health and Biomedical Sciences, RMIT University, PO Box 71, Bundoora, VIC 3083 Australia
| | - Priya M. Kevat
- James Cook University, College of Medicine and Dentistry, PO Box 6811, Cairns, QLD 4870 Australia
- Present Address: Royal Children’s Hospital Melbourne, 50 Flemington Road, Parkville, VIC 3052 Australia
| | - Marc G. W. Rémond
- James Cook University, College of Medicine and Dentistry, PO Box 6811, Cairns, QLD 4870 Australia
- Baker IDI, PO Box 6492, Melbourne, VIC 3004 Australia
| | - Graeme P. Maguire
- James Cook University, College of Medicine and Dentistry, PO Box 6811, Cairns, QLD 4870 Australia
- Baker IDI, PO Box 6492, Melbourne, VIC 3004 Australia
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Wyber R, Boyd BJ, Colquhoun S, Currie BJ, Engel M, Kado J, Karthikeyan G, Sullivan M, Saxena A, Sheel M, Steer A, Mucumbitsi J, Zühlke L, Carapetis J. Preliminary consultation on preferred product characteristics of benzathine penicillin G for secondary prophylaxis of rheumatic fever. Drug Deliv Transl Res 2016; 6:572-8. [DOI: 10.1007/s13346-016-0313-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Roberts KV, Maguire GP, Brown A, Atkinson DN, Remenyi B, Wheaton G, Ilton M, Carapetis J. Rheumatic heart disease in Indigenous children in northern Australia: differences in prevalence and the challenges of screening. Med J Aust 2016; 203:221.e1-7. [PMID: 26852054 DOI: 10.5694/mja15.00139] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/19/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare regional differences in the prevalence of rheumatic heart disease (RHD) detected by echocardiographic screening in high-risk Indigenous Australian children, and to describe the logistical and other practical challenges of RHD screening. DESIGN Cross-sectional screening survey performed between September 2008 and November 2010. SETTING Thirty-two remote communities in four regions of northern and central Australia. PARTICIPANTS 3946 Aboriginal or Torres Strait Islander children aged 5-15 years. INTERVENTION Portable echocardiography was performed by cardiac sonographers. Echocardiograms were recorded and reported offsite by a pool of cardiologists. MAIN OUTCOME MEASURES RHD was diagnosed according to 2012 World Heart Federation criteria. RESULTS The prevalence of definite RHD differed between regions, from 4.7/1000 in Far North Queensland to 15.0/1000 in the Top End of the Northern Territory. The prevalence of definite RHD was greater in the Top End than in other regions (odds ratio, 2.3; 95% CI, 1.2-4.6, P = 0.01). Fifty-three per cent of detected cases of definite RHD were new cases; the prevalence of new cases of definite RHD was 4.6/1000 for the entire sample and 7.0/1000 in the Top End. Evaluation of socioeconomic data suggests that the Top End group was the most disadvantaged in our study population. CONCLUSIONS The prevalence of definite RHD in remote Indigenous Australian children is significant, with a substantial level of undetected disease. Important differences were noted between regions, with the Top End having the highest prevalence of definite RHD, perhaps explained by socioeconomic factors. Regional differences must be considered when evaluating the potential benefit of widespread echocardiographic screening in Australia.
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Affiliation(s)
| | | | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, SA
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Rémond MGW, Coyle ME, Mills JE, Maguire GP. Approaches to Improving Adherence to Secondary Prophylaxis for Rheumatic Fever and Rheumatic Heart Disease. Cardiol Rev 2016; 24:94-8. [DOI: 10.1097/crd.0000000000000065] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Mirabel M, Tafflet M, Noël B, Parks T, Axler O, Robert J, Nadra M, Phelippeau G, Descloux E, Cazorla C, Missotte I, Gervolino S, Barguil Y, Rouchon B, Laumond S, Jubeau T, Braunstein C, Empana JP, Marijon E, Jouven X. Newly diagnosed rheumatic heart disease among indigenous populations in the Pacific. Heart 2015; 101:1901-6. [PMID: 26537732 PMCID: PMC4680122 DOI: 10.1136/heartjnl-2015-308237] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 10/02/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Rheumatic heart disease (RHD) remains the leading acquired heart disease in the young worldwide. We aimed at assessing outcomes and influencing factors in the contemporary era. METHODS Hospital-based cohort in a high-income island nation where RHD remains endemic and the population is captive. All patients admitted with newly diagnosed RHD according to World Heart Federation echocardiographic criteria were enrolled (2005-2013). The incidence of major cardiovascular events (MACEs) including heart failure, peripheral embolism, stroke, heart valve intervention and cardiovascular death was calculated, and their determinants identified. RESULTS Of the 396 patients, 43.9% were male with median age 18 years (IQR 10-40)). 127 (32.1%) patients presented with mild, 131 (33.1%) with moderate and 138 (34.8%) with severe heart valve disease. 205 (51.8%) had features of acute rheumatic fever. 106 (26.8%) presented with at least one MACE. Among the remaining 290 patients, after a median follow-up period of 4.08 (95% CI 1.84 to 6.84) years, 7 patients (2.4%) died and 62 (21.4%) had a first MACE. The annual incidence of first MACE and of heart failure were 59.05‰ (95% CI 44.35 to 73.75) and 29.06‰ (95% CI 19.29 to 38.82), respectively. The severity of RHD at diagnosis (moderate vs mild HR 3.39 (0.95 to 12.12); severe vs mild RHD HR 10.81 (3.11 to 37.62), p<0.001) and ongoing secondary prophylaxis at follow-up (HR 0.27 (0.12 to 0.63), p=0.01) were the two most influential factors associated with MACE. CONCLUSIONS Newly diagnosed RHD is associated with poor outcomes, mainly in patients with moderate or severe valve disease and no secondary prophylaxis.
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Affiliation(s)
- Mariana Mirabel
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Muriel Tafflet
- INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Baptiste Noël
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | | | - Olivier Axler
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Jacques Robert
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Marie Nadra
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Gwendolyne Phelippeau
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Elodie Descloux
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Cécile Cazorla
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Isabelle Missotte
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Shirley Gervolino
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Yann Barguil
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Bernard Rouchon
- Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Sylvie Laumond
- Direction des Affaires Sanitaires et Sociales, Nouméa, New Caledonia
| | - Thierry Jubeau
- Département des Evacuations Sanitaires, Contrôle Médical Unifié, CAFAT, Nouméa, New Caledonia
| | - Corinne Braunstein
- Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Jean-Philippe Empana
- INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Eloi Marijon
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Xavier Jouven
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Are minor echocardiographic changes associated with an increased risk of acute rheumatic fever or progression to rheumatic heart disease? Int J Cardiol 2015; 198:117-22. [DOI: 10.1016/j.ijcard.2015.07.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/16/2015] [Accepted: 07/02/2015] [Indexed: 12/25/2022]
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Russell EA, Tran L, Baker RA, Bennetts JS, Brown A, Reid CM, Tam R, Walsh WF, Maguire GP. A review of outcome following valve surgery for rheumatic heart disease in Australia. BMC Cardiovasc Disord 2015; 15:103. [PMID: 26399240 PMCID: PMC4580994 DOI: 10.1186/s12872-015-0094-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/14/2015] [Indexed: 11/15/2022] Open
Abstract
Background Globally, rheumatic heart disease (RHD) remains an important cause of heart disease. In Australia it particularly affects younger Indigenous and older non-Indigenous Australians. Despite its impact there is limited understanding of the factors influencing outcome following surgery for RHD. Methods The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed to assess outcomes following surgical procedures for RHD and non-RHD valvular disease. The association with demographics, co-morbidities, pre-operative status, valve(s) affected and operative procedure was evaluated. Results Outcome of 1384 RHD and 15843 non-RHD valve procedures was analysed. RHD patients had longer ventilation, experienced fewer strokes and had more readmissions to hospital and anticoagulant complications. Mortality following RHD surgery at 30 days was 3.1 % (95 % CI 2.2 – 4.3), 5 years 15.3 % (11.7 – 19.5) and 10 years 25.0 % (10.7 – 44.9). Mortality following non-RHD surgery at 30 days was 4.3 % (95 % CI 3.9 - 4.6), 5 years 17.6 % (16.4 - 18.9) and 10 years 39.4 % (33.0 - 46.1). Factors independently associated with poorer longer term survival following RHD surgery included older age (OR1.03/additional year, 95 % CI 1.01 – 1.05), concomitant diabetes (OR 1.7, 95 % CI 1.1 – 2.5) and chronic kidney disease (1.9, 1.2 – 2.9), longer invasive ventilation time (OR 1.7 if greater than median value, 1.1– 2.9) and prolonged stay in hospital (1.02/additional day, 1.01 – 1.03). Survival in Indigenous Australians was comparable to that seen in non-Indigenous Australians. Conclusion In a large prospective cohort study we have demonstrated survival following RHD valve surgery in Australia is comparable to earlier studies. Patients with diabetes and chronic kidney disease, were at particular risk of poorer long-term survival. Unlike earlier studies we did not find pre-existing atrial fibrillation, being an Indigenous Australian or the nature of the underlying valve lesion were independent predictors of survival.
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Affiliation(s)
- E Anne Russell
- Baker IDI, Melbourne, VIC, 3004, Australia. .,School of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Lavinia Tran
- School of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Robert A Baker
- Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Adelaide, South Australia.
| | - Jayme S Bennetts
- Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Adelaide, South Australia. .,Department of Surgery, School of Medicine, Flinders University, Adelaide, South Australia.
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australia Health and Medical Research Institute, Adelaide, South Australia. .,School of Population Health, University of South Australia, Adelaide, South Australia.
| | - Christopher M Reid
- School of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. .,School of Public Health, Curtin University, Perth, Western Australia.
| | - Robert Tam
- Director of Surgery, Department of Cardiothoracic Surgery, Townsville Hospital, Queensland, Australia.
| | | | - Graeme P Maguire
- Baker IDI, Melbourne, VIC, 3004, Australia. .,School of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. .,School of Medicine, James Cook University, Cairns, QLD, Australia.
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Hofer A, Parker J, Atkinson D, Moore S, Reeve C, Mak DB. Prevocational exposure to public health in the Kimberley: a pathway to rural, remote and public health practice. Aust J Rural Health 2015; 22:75-9. [PMID: 24731204 DOI: 10.1111/ajr.12089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the Kimberley Population Health Unit (KPHU) prevocational public health placement in terms of its contribution to resident medical officers' (RMOs') knowledge, skills, career path and aspirations. DESIGN All RMOs who had completed a public health placement at the KPHU (n=27) during 2001-2012 were invited to complete an online survey in September 2012. SETTING The KPHU, based in Broome, provides population health services to the Kimberley region, far north Western Australia. MAIN OUTCOME MEASURES The extent to which RMOs perceived the development of public health skills and knowledge during the placement, and the degree to which RMOs believe this placement influenced future career pathways and their current practice. RESULTS Twenty-three RMOs (85%) completed the survey. Sixty per cent are currently working in general practice or public health medicine; of these, 43% have returned to the Kimberley. Over 70% reported that the placement developed their knowledge of public health and Aboriginal health to a 'great' or 'very great' extent. Sixty-one per cent felt that their placement influenced their future desire to work in public health 'a lot' or 'a great extent'. CONCLUSION This placement provides a unique opportunity for RMOs to undertake public health and Aboriginal health work in a remote setting. Given the increasing demand for prevocational placements, the value of imparting sound public health knowledge to the next generation of doctors and the urgent need to recruit and retain rural doctors, this placement provides a potential model that could be expanded to other locations.
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Affiliation(s)
- Alexandra Hofer
- Kimberley Population Health Unit, Western Australia Country Health Service, Broome, Western Australia, Australia
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Rémond MGW, Maguire GP. Echocardiographic screening for rheumatic heart disease-some answers, but questions remain. Transl Pediatr 2015; 4:206-9. [PMID: 26835376 PMCID: PMC4729054 DOI: 10.3978/j.issn.2224-4336.2015.05.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Despite being preventable, rheumatic heart disease (RHD) remains a significant global cause of cardiovascular disease. Echocardiographic screening for early detection of RHD has the potential to enable timely commencement of treatment (secondary prophylaxis) to halt progression to severe valvular disease. However, a number of issues remain to be addressed regarding its feasibility. The natural history of Definite RHD without a prior history of acute rheumatic fever (ARF) and Borderline RHD are both unclear. Even if they are variants of RHD it is not known whether secondary antibiotic prophylaxis will prevent disease progression as it does in "traditionally" diagnosed RHD. False positives can also have a detrimental impact on individuals and their families as well as place substantial burdens on health care systems. Recent research suggests that handheld echocardiography (HAND) may offer a cheaper and more convenient alternative to standard portable echocardiography (STAND) in RHD screening. However, while HAND is sensitive for the detection of Definite RHD, it is less sensitive for Borderline RHD and is relatively poor at detecting mitral stenosis (MS). Given its attendant limited specificity, potential cases detected with HAND would require re-examination by standard echocardiography. For now, echocardiographic screening for RHD should remain a subject of research rather than routine health care.
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Affiliation(s)
- Marc G W Rémond
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - Graeme P Maguire
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia
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Zühlke L, Engel ME, Karthikeyan G, Rangarajan S, Mackie P, Cupido B, Mauff K, Islam S, Joachim A, Daniels R, Francis V, Ogendo S, Gitura B, Mondo C, Okello E, Lwabi P, Al-Kebsi MM, Hugo-Hamman C, Sheta SS, Haileamlak A, Daniel W, Goshu DY, Abdissa SG, Desta AG, Shasho BA, Begna DM, ElSayed A, Ibrahim AS, Musuku J, Bode-Thomas F, Okeahialam BN, Ige O, Sutton C, Misra R, Abul Fadl A, Kennedy N, Damasceno A, Sani M, Ogah OS, Olunuga T, Elhassan HHM, Mocumbi AO, Adeoye AM, Mntla P, Ojji D, Mucumbitsi J, Teo K, Yusuf S, Mayosi BM. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study). Eur Heart J 2014; 36:1115-22a. [PMID: 25425448 DOI: 10.1093/eurheartj/ehu449] [Citation(s) in RCA: 344] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 10/23/2014] [Indexed: 11/14/2022] Open
Abstract
AIMS Rheumatic heart disease (RHD) accounts for over a million premature deaths annually; however, there is little contemporary information on presentation, complications, and treatment. METHODS AND RESULTS This prospective registry enrolled 3343 patients (median age 28 years, 66.2% female) presenting with RHD at 25 hospitals in 12 African countries, India, and Yemen between January 2010 and November 2012. The majority (63.9%) had moderate-to-severe multivalvular disease complicated by congestive heart failure (33.4%), pulmonary hypertension (28.8%), atrial fibrillation (AF) (21.8%), stroke (7.1%), infective endocarditis (4%), and major bleeding (2.7%). One-quarter of adults and 5.3% of children had decreased left ventricular (LV) systolic function; 23% of adults and 14.1% of children had dilated LVs. Fifty-five percent (n = 1761) of patients were on secondary antibiotic prophylaxis. Oral anti-coagulants were prescribed in 69.5% (n = 946) of patients with mechanical valves (n = 501), AF (n = 397), and high-risk mitral stenosis in sinus rhythm (n = 48). However, only 28.3% (n = 269) had a therapeutic international normalized ratio. Among 1825 women of childbearing age (12-51 years), only 3.6% (n = 65) were on contraception. The utilization of valvuloplasty and valve surgery was higher in upper-middle compared with lower-income countries. CONCLUSION Rheumatic heart disease patients were young, predominantly female, and had high prevalence of major cardiovascular complications. There is suboptimal utilization of secondary antibiotic prophylaxis, oral anti-coagulation, and contraception, and variations in the use of percutaneous and surgical interventions by country income level.
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Affiliation(s)
- Liesl Zühlke
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Groote Schuur Hospital, Groote Schuur Drive, Observatory 7925, Cape Town, South Africa Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Mark E Engel
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Groote Schuur Hospital, Groote Schuur Drive, Observatory 7925, Cape Town, South Africa
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Pam Mackie
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Blanche Cupido
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Groote Schuur Hospital, Groote Schuur Drive, Observatory 7925, Cape Town, South Africa
| | - Katya Mauff
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Shofiqul Islam
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Alexia Joachim
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Groote Schuur Hospital, Groote Schuur Drive, Observatory 7925, Cape Town, South Africa
| | - Rezeen Daniels
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Groote Schuur Hospital, Groote Schuur Drive, Observatory 7925, Cape Town, South Africa
| | - Veronica Francis
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Groote Schuur Hospital, Groote Schuur Drive, Observatory 7925, Cape Town, South Africa
| | - Stephen Ogendo
- Department of Surgery, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Bernard Gitura
- Cardiology Unit, Department of Medicine, Kenyatta National Teaching and Referral Hospital, Nairobi, Kenya
| | - Charles Mondo
- Cardiology Unit, Department of Medicine, Mulago Hospital, Kampala, Uganda
| | | | | | - Mohammed M Al-Kebsi
- Faculty of Medicine and Surgery, University of Sana'a, Al-Thawrah Cardiac Center, Sana'a, Yemen
| | - Christopher Hugo-Hamman
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa Paediatric Cardiology Service, Windhoek Central Hospital, Windhoek, Namibia
| | - Sahar S Sheta
- Department of Paediatrics, Division of Paediatric Cardiology, Faculty of Medicine, Cairo University Children's Hospital, Cairo, Egypt
| | - Abraham Haileamlak
- Department of Paediatrics and Child Health, Jimma University Hospital, Jimma, Ethiopia
| | - Wandimu Daniel
- Department of Paediatrics and Child Health, Jimma University Hospital, Jimma, Ethiopia
| | - Dejuma Y Goshu
- Department of Internal Medicine, Faculty of Medicine, Addis Ababa, Ethiopia
| | - Senbeta G Abdissa
- Department of Internal Medicine, Faculty of Medicine, Addis Ababa, Ethiopia
| | - Araya G Desta
- Department of Internal Medicine, Faculty of Medicine, Addis Ababa, Ethiopia
| | - Bekele A Shasho
- Department of Internal Medicine, Faculty of Medicine, Addis Ababa, Ethiopia
| | - Dufera M Begna
- Department of Internal Medicine, Faculty of Medicine, Addis Ababa, Ethiopia
| | - Ahmed ElSayed
- Department of Cardiothoracic Surgery, Al Shaab Teaching Hospital, Faculty of Medicine, Alzaiem Alazhari University, Khartoum, Sudan
| | - Ahmed S Ibrahim
- Department of Cardiothoracic Surgery, Al Shaab Teaching Hospital, Faculty of Medicine, Alzaiem Alazhari University, Khartoum, Sudan
| | - John Musuku
- Department of Paediatrics and Child Health, University Teaching Hospital, University of Zambia, Lusaka, Zambia
| | | | - Basil N Okeahialam
- Department of Paediatrics, Jos University Teaching Hospital, Jos, Nigeria
| | - Olukemi Ige
- Department of Paediatrics, Jos University Teaching Hospital, Jos, Nigeria
| | - Christopher Sutton
- Department of Paediatrics and Child Health, University of Limpopo, Polokwane, South Africa
| | - Rajeev Misra
- Department of Internal Medicine, University of Limpopo, Polokwane, South Africa
| | | | - Neil Kennedy
- Department of Paediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Mahmoud Sani
- Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Okechukwu S Ogah
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria Nigeria Ministry of Health, Umuahia, Abia State, Nigeria Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Taiwo Olunuga
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | | | - Ana Olga Mocumbi
- Instituto Nacional de Saúde and Eduardo Mondlane University, Maputo, Mozambique
| | - Abiodun M Adeoye
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Phindile Mntla
- Department of Cardiology, Dr. George Mukhari Hospital and University of Limpopo (MEDUNSA Campus), Tshwane, South Africa
| | - Dike Ojji
- Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Joseph Mucumbitsi
- Paediatric Cardiology Unit, Department of Paediatrics, King Faisal Hospital, Kigali, Rwanda
| | - Koon Teo
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Bongani M Mayosi
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Groote Schuur Hospital, Groote Schuur Drive, Observatory 7925, Cape Town, South Africa
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Russell EA, Tran L, Baker RA, Bennetts JS, Brown A, Reid CM, Tam R, Walsh WF, Maguire GP. A review of valve surgery for rheumatic heart disease in Australia. BMC Cardiovasc Disord 2014; 14:134. [PMID: 25274483 PMCID: PMC4196004 DOI: 10.1186/1471-2261-14-134] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 09/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, rheumatic heart disease (RHD) remains an important cause of heart disease. In Australia it particularly affects older non-Indigenous Australians and Aboriginal Australians and/or Torres Strait Islander peoples. Factors associated with the choice of treatment for advanced RHD remain variable and poorly understood. METHODS The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed. Demographics, co-morbidities, pre-operative status and valve(s) affected were collated and associations with management assessed. RESULTS Surgical management of 1384 RHD and 15843 non-RHD valve procedures was analysed. RHD patients were younger, more likely to be female and Indigenous Australian, to have atrial fibrillation (AF) and previous percutaneous balloon valvuloplasty (PBV). Surgery was performed on one valve in 64.5%, two valves in 30.0% and three valves in 5.5%. Factors associated with receipt of mechanical valves in RHD were AF (OR 2.69) and previous PBV (OR 1.98) and valve surgery (OR 3.12). Predictors of valve repair included being Indigenous (OR 3.84) and having fewer valves requiring surgery (OR 0.10). Overall there was a significant increase in the use of mitral bioprosthetic valves over time. CONCLUSIONS RHD valve surgery is more common in young, female and Indigenous patients. The use of bioprosthetic valves in RHD is increasing. Given many patients are female and younger, the choice of valve surgery and need for anticoagulation has implications for future management of RHD and related morbidity, pregnancy and lifestyle plans.
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Affiliation(s)
- Elizabeth Anne Russell
- />Baker IDI Central Australia, PO Box 1294, Alice Springs, NT 0811 Australia
- />School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Lavinia Tran
- />School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Robert A Baker
- />Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Adelaide, SA Australia
| | - Jayme S Bennetts
- />Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Adelaide, SA Australia
- />Department of Surgery, School of Medicine, Flinders University, Adelaide, SA Australia
| | - Alex Brown
- />Wardliparingga Aboriginal Research Unit, South Australia Health and Medical Research Institute, Adelaide, SA Australia
- />School of Population Health, University of South Australia, Adelaide, SA Australia
| | - Christopher Michael Reid
- />School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Robert Tam
- />Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia
| | | | - Graeme Paul Maguire
- />Baker IDI Central Australia, PO Box 1294, Alice Springs, NT 0811 Australia
- />School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria Australia
- />School of Medicine, James Cook University, Cairns, Queensland Australia
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Murdoch J, Davis S, Forrester J, Masuda L, Reeve C. Acute rheumatic fever and rheumatic heart disease in the Kimberley: using hospitalisation data to find cases and describe trends. Aust N Z J Public Health 2014; 39:38-43. [PMID: 25169025 DOI: 10.1111/1753-6405.12240] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/01/2014] [Accepted: 02/01/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe the epidemiology of hospitalisations due to acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in the Kimberley region of Western Australia (WA) and use these data to improve completeness of the WA RHD Register. METHODS Retrospective analysis of Kimberley regional hospitalisation data for hospitalisations coded as ARF/RHD from 01/07/2002 to 30/06/2012, with individual follow-up of those not on the register. Annual age-standardised hospitalisation rates were calculated to determine hospitalisation trend. RESULTS There were 250 admissions among 193 individuals. Of these, 53 individuals (27%) with confirmed or probable ARF/RHD were not on the register. Males were less likely to be on the register (62% versus 79% of females, p<0.01), as were those hospitalised with ARF without heart involvement (68% versus 87% of other ARF diagnoses, p<0.01). ARF/RHD hospitalisation rates decreased by 8.8% per year (p<0.001, rate ratio = 0.91, 95%CI 0.87-0.96). CONCLUSIONS AND IMPLICATIONS Using hospitalisation data is an effective method of identifying cases of ARF/RHD not currently on the register. This process could be undertaken for initial case finding in areas with newly established registers, or as regular quality assurance in areas with established register-based programs. Reasons for the observed decrease in hospitalisation rates remain unclear and warrant further investigation.
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Hofer A, Woodland S, Carole R. Mortality due to rheumatic heart disease in the Kimberley 2001-2010. Aust N Z J Public Health 2013; 38:139-41. [DOI: 10.1111/1753-6405.12112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Alexandra Hofer
- Kimberley Population Health Unit, Western Australia Country Health Service
| | - Sarah Woodland
- Kimberley Population Health Unit, Western Australia Country Health Service
| | - Reeve Carole
- Kimberley Population Health Unit, Western Australia Country Health Service
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Wiemers P, Marney L, Muller R, Brandon M, Kuchu P, Kuhlar K, Uchime C, Kang D, White N, Greenup R, Fraser JF, Yadav S, Tam R. Cardiac surgery in Indigenous Australians--how wide is 'the gap'? Heart Lung Circ 2013; 23:265-72. [PMID: 24321647 DOI: 10.1016/j.hlc.2013.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 08/11/2013] [Accepted: 09/07/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cardiovascular disease remains the leading cause of mortality in the Indigenous Australian population. Limited research exists in regards to cardiac surgery in the Aboriginal and Torres Strait Islander (ATSI) population. We aimed to investigate risk profiles, surgical pathologies, surgical management and short term outcomes in a contemporary group of patients. METHODS Variables were assessed for 557 consecutive patients who underwent surgery at our institution between August 2008 and March 2010. RESULTS 19.2% (107/557) of patients were of Indigenous origin. ATSI patients were significantly younger at time of surgery (mean age 54.1±13.23 vs. 63.1±12.46; p=<0.001) with higher rates of preventable risk factors. Rheumatic heart disease (RHD) was the dominant valvular pathology observed in the Indigenous population. Significantly higher rates of left ventricular impairment and more diffuse coronary artery disease were observed in ATSI patients. A non-significant trend towards higher 30-day mortality was observed in the Indigenous population (5.6% vs. 3.1%; p=0.244). CONCLUSIONS Cardiac surgery is generally required at a younger age in the Indigenous population with patients often presenting with more advanced disease. Despite often more advanced disease, surgical outcomes do not differ significantly from non-Indigenous patients. Continued focus on preventative strategies for coronary artery disease and RHD in the Indigenous population is required.
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Affiliation(s)
- Paul Wiemers
- Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia; University of Queensland School of Medicine, Brisbane, Australia.
| | - Lucy Marney
- Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia
| | - Reinhold Muller
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia
| | - Matthew Brandon
- Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia
| | - Praveen Kuchu
- Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia
| | - Kasandra Kuhlar
- Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia
| | - Chimezie Uchime
- Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia
| | - Dong Kang
- Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia
| | - Nicole White
- Mathematical Sciences School, Queensland University of Technology, Brisbane, Australia
| | - Rachel Greenup
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Australia
| | - John F Fraser
- University of Queensland School of Medicine, Brisbane, Australia; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Sumit Yadav
- Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia
| | - Robert Tam
- Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia
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Maguire GP, Carapetis JR, Walsh WF, Brown ADH. The future of acute rheumatic fever and rheumatic heart disease in Australia. Med J Aust 2012; 197:133-4. [PMID: 22860775 DOI: 10.5694/mja12.10980] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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