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Rheumatic heart disease (RHD) is underdiagnosed globally resulting in missed treatment opportunities and adverse clinical outcomes. We describe the protocol for a study which aims to co-design, implement and conduct an evaluation of a task-sharing approach to echocardiographic active case finding for early detection and management of RHD in high-risk settings in Australia and Timor-Leste.
Rheumatic heart disease (RHD) is the most important cause of acquired cardiovascular disease in children and young adults. Virtually non-existent in most of Australia, it still predominantly affects Aboriginal communities.
Acute rheumatic fever and rheumatic heart disease are caused by untreated group A streptococcus infections. Their prevalence is much higher among First Nations people than other Australians.
This research sought to provide an outline of identified household-level environmental health initiatives to reduce or interrupt Strep A transmission along each of these pathways.
Rheumatic heart disease is a major cause of premature cardiovascular morbidity and mortality globally. Over the past decade, echocardiographic screening has changed our understanding of the natural history of RHD, revealing a high burden of clinically silent, mild RHD among people who cannot recall a history of preceding acute rheumatic fever. This viewpoint outlines the evidence that this earliest form of rheumatic heart disease, only detectable through echocardiographic screening, is an intermediate stage that many, but not all, individuals may pass through on the pathway to advanced rheumatic heart disease.
The social determinants of health such as access to income, education, housing and healthcare, strongly shape the occurrence of acute rheumatic fever and rheumatic heart disease at the household, community and national levels.
Jonathan Carapetis AM AM MBBS FRACP FAFPHM PhD FAHMS Co-Head, Strep A Translation; Co-Founder of REACH 08 6319 1000 contact@thekids.org.au Head,
Although entirely preventable, rheumatic heart disease, a disease of poverty and social disadvantage resulting in high morbidity and mortality, remains an ever-present burden in low-income and middle-income countries and rural, remote, marginalised and disenfranchised populations within high-income countries.
Secondary prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) involves continuous antimicrobial prophylaxis among affected individuals and is recognised as a cornerstone of public health programmes that address these conditions. However, several important scientific issues around the secondary prevention paradigm remain unresolved.
This study aimed to investigate potential missed diagnoses of acute rheumatic fever and rheumatic heart disease during hospital-based care among persons subsequently identified with these conditions.