Burden of Disease
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) were once common across Europe, North America and the Pacific.1,2 Rates of ARF and RHD declined in most of these countries during the mid-20th century, primarily in response to reduced household crowding, improved socioeconomic conditions and access to healthcare, and the wider availability of penicillin to treat streptococcal infections.3,4 By contrast, high rates of disease continued among young people across many low- and middle-income countries, where widespread poverty persisted and access to health services was difficult.5
Today, many high-income countries have a residual burden of RHD among older surviving adults who developed ARF in their youth, prior to improvements in socioeconomic conditions and antibiotic treatment. There are also some Indigenous minority populations living in high-income countries that continue to be affected by ARF and RHD, including children and young people.6
Australia’s Aboriginal and Torres Strait Islander peoples and New Zealand Māori and Pacific Islanders experience a significantly high burden of ARF and RHD. These groups also experience considerable inequalities across a wide range of social, educational and health outcomes compared with the general population.7,8,9
ARF and RHD in Australia
- Since the early 1990s, ARF has occurred almost exclusively in young Aboriginal and Torres Strait Islander peoples, particularly in children aged 5-14-years.6
- Females are more likely to be diagnosed with ARF and RHD than males, and rates of disease are higher across northern Australia.6
- The number of Aboriginal and Torres Strait Islander peoples affected by ARF and RHD appears to be increasing, however the exact reason for this is not clear.6
- People who have had ARF are more likely to have ARF again, with one in five people having a recurrent episode of ARF within 10 years of their first.10
- The burden of disease often lasts most of a person’s lifetime, starting with ARF in childhood and progressing to RHD, with associated heart complications during adulthood.
- Complications from RHD are common, and include atrial fibrillation, endocarditis, heart failure and stroke.10
- Aboriginal and Torres Strait Islander peoples with RHD are more likely to die compared to non-Indigenous Australians with RHD; however, the death rate for both groups is decreasing.11
- Sullivan E, Vaughan G, Li Z, et al. The high prevalence and impact of rheumatic heart disease in pregnancy in First Nations populations in a high-income setting: a prospective cohort study. BJOG: An International Journal of Obstetrics & Gynaecology. 2019;27(1):47-56.
- Hajar R. Rheumatic Fever and Rheumatic Heart Disease a Historical Perspective. Heart Views. 2016;17(3):120-126.
- Gordis L. The virtual disappearance of rheumatic fever in the United States: lessons in the rise and fall of disease. T. Duckett Jones memorial lecture. Circulation. 1985;72(6):1155-1162.
- Bland EF. Rheumatic fever: the way it was. Circulation. 1987;76(6):1190-1195.
- Zühlke L, Engel ME, Karthikeyan G, et al. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: The Global Rheumatic Heart Disease Registry (the REMEDY study). European Heart Journal. 2015;36(18):1115-1122a
- Australian Institute of Health and Welfare. Acute rheumatic fever and rheumatic heart disease in Australia. Cat. no: CVD 86. Australian Institute of Health and Welfare, Canberra, 2019
- Baker MG, Barnard LT, Kvalsvig A, et al. Increasing incidence of serious infectious diseases and inequalities in New Zealand: a national epidemiological study. The Lancet. 2012;379;(9821):1112-1119.
- World Health Organization. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva Switzerland, 2008.
- Carapetis JR, Zühlke L, Taubert K, Narula J. Continued challenge of rheumatic heart disease: The gap of understanding or the gap of implementation? Global Heart .2013;8(8):185-186.
- He VYF, Condon JR, Ralph AP, et al. Long-term outcomes from acute rheumatic fever and rheumatic heart disease: A data-linkage and survival analysis approach. Circulation. 2016;134:222-232.
- Colquhoun SM, Condon JR, Steer AC, et al. Disparity in mortality from Rheumatic Heart Disease in Indigenous Australians. Journal of the American Heart Association. 2015;4(7).
LAST UPDATED 6 JUNE 2020