Australia has one of the highest rates of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in the world. Indigenous people are up to eight times more likely than other groups to be hospitalised and nearly 20 times as likely to die from this disease.
ARF is caused by an immunological response to group A streptococcal (GAS) infection and can lead to permanent heart damage, a condition known as RHD. Globally, RHD is the most common cause of cardiac death in children and adults aged under 40 years. However, through simple and cost effective strategies, almost all cases of RHD and associated deaths are preventable.
There are at least 15.6 million people with RHD worldwide and, annually, over 230 000 people die from the disease. There are another 1.9 million people with a history of ARF and 470 000 new cases are diagnosed every year. These figures, however, are likely to be an underestimate of the true burden of the disease.
Some of the highest rates of ARF and RHD in the world are found in Indigenous Australians (particularly across central and northern Australia), Maoris and Pacific Island populations. The Pacific region, including Fiji, has the highest reported prevalence of RHD. The prevalence of RHD is also high in sub-Saharan Africa, Latin America, the Indian subcontinent, the Middle East and Northern Africa. Menzies' researchers work with high risk populations in Australia and the Pacific Region.
Incidence of ARF and RHD falls dramatically with improved living conditions and increased hygiene standards, along with better access to appropriate health services and penicillin-based medications (known as secondary prophylaxis).
Menzies’ research mainly targets primary and secondary prevention of ARF and RHD. This means stopping people from getting the disease in the first place, but if they do get it, treating them to keep them healthy.
Our research focus:
- To test whether a model of care designed to optimise health systems and community resources improves adherence to secondary prophylaxis for RHD
- To understand why ARF converts to RHD in some people. Many Indigenous Australians will get group A streptococcus infections but only some will develop RHD. Launched in 2012, RHD Genetics is a collaborative study into the role genetics plays in the disease’s presence and progression
- To provide an evidence base to improve clinical care and outcomes for women with RHD in pregnancy and for their babies
- To find markers in the blood that can be used to rapidly and accurately diagnose ARF so people can get the treatment they need as soon as possible
- To establish the prevalence of RHD in high-risk Indigenous Australian children and to compare the findings with children at low risk for RHD and to determine the accuracy of cardiac auscultation in detecting echocardiographically- confirmed RHD
To provide direct program support and conduct research under the World Heart Federation RHD Pacific and International Program, including:
- RHD genetics study in Fiji and New Caledonia.
- A BPG adherence study in Fiji
- A cost analysis of burden of RHD in New Caledonia and Fiji
- An evaluation of the ASAP RHD program in South Africa and Ethiopia
- Development of an RHD train the trainer module for international and regional Pacific use
- Collaboration and sharing of resources with many other countries in Asia, Africa and South America.
Our research impact:
- RHDAustralia was established in 2009 as the National Coordination Unit to support control of rheumatic heart disease in Australia and is based at Menzies School of Health Research, Darwin. RHDAustralia partners with Baker IDI, James Cook University, Telethon Kids Institute and South Australian Health and Medical Research Institute. RHDAustralia is funded under the Department of Health's Rheumatic Fever Strategy.
- In partnership with the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand, RHDAustralia led a review of the national guidelines (published in 2006) based on new evidence.
- RHDAustralia developed ipad, iPhone and Android applications for clinicians based on the latest diagnosis and management guidelines.
- RHDAustralia created a series of five online interactive modules to provide the health workforce with an introductory-level understanding of best practice approaches to the prevention, diagnosis and management of ARF and RHD.
- Developed 15 specialised modules for clinicians, by clinicians, on rheumatic heart disease topics such as pregnancy, medical management of mitral valve disease, medical management of aortic valve disease and dental care.
Key rheumatic heart disease staff:
- Professor Bart Currie, director RHDAustralia
- Associate Professor Anna Ralph
- Dr Steven Tong
- Dr Bo Remenyi
- Jessica de Dassel
- Kylie Tune
- Melita McKinnon
- Samantha Colquhoun
Key RHDAustralia staff:
- Professor Bart Currie, director
- Claire Boardman, deputy director
- Catherine Halkon, project officer
- Catherine Milne, database liaison
- Sandra Downing, epidemiologist
- Rosemary Harbridge, project officer
- Samantha Colquhoun, consultant
- Sara Noonan, technical advisor
- Baker IDI Heart and Diabetes Institute
- South Australian Health and Medical Research Institute
- Telethon Institute for Child Health Research
- South Australian Health and Medical Research Institute.
- Analysis of mortality trends for rheumatic heart disease (RHD) and rheumatic fever in Indigenous and non-Indigenous Australians
- Echocardiographic screening for RHD by nurses in Fiji – testing of a training module
- The global burden of disease study 2010: RHD writing group
- Reducing rheumatic fever and controlling RHD in Pacific Island Nations
- Improving delivery of secondary prophylaxis for RHD: a stepped-wedge, community-randomised trial
- RHDAustralia, national coordination unit for RHD
- RHD in pregnancy
- Evaluating the genetic contribution to RHD pathogenesis in Australian Aboriginal and Torres Strait Islander communities
- Identifying a unique inflammatory signature in ARF – a pilot study
gECHO study (RHD screening study).
Click here to view rheumatic heart disease publications in PubMed.
RHDAustralia has developed a suite of educational resources, based on the Australian guideline for the prevention, diagnosis and management of ARF and RHD (2nd edition), for health professionals and communities. These can be accessed on the RHDAustralia website, along with a resource database of Australian ARF and RHD educational tools.
For the latest articles click here to be taken to the RHDAustralia news website.
RHD Australia will mark World Heart Day on 29 September by reminding people that rheumatic heart disease is preventable. Diagnosed at the age of seven, Carlisa Willika from the Werenbun community north of Katherine in the Northern Territory has lived with rheumatic heart disease for five years.
Experts from around the country will meet in Darwin today at the RHD Australia Conference 2013: Practice and Culture to strengthen Australia’s fight to prevent rheumatic heart disease.
A leading paediatric cardiologist has emphasised the need to prevent RHD in Indigenous children to avoid premature death, cardiac surgery and stroke to allow them to live a fulfilling life.
200 international leading experts and advocates for rheumatic heart disease will converge at the 3rd Global Rheumatic Heart Disease Forum in Melbourne next week.
RHDAustralia will host a free seminar in Cairns tonight as part of Australia’s Rheumatic Fever Strategy to reduce the world’s highest recorded rate of acute rheumatic fever.
RHDAustralia will launch 15 new ‘clinician e-learning modules’ at a seminar in Darwin as part of Australia’s Rheumatic Fever Strategy to tackle the world’s highest recorded rate of acute rheumatic fever and rheumatic heart disease.
Rheumatic heart disease: Preventable illness in Indigenous communities 'a national failure', AMA says
The Australian Medical Association has singled out a preventable disease caused by impoverished living conditions and untreated infections as Australia's "national failure".
Australian doctors are working with East Timorese health workers to screen and treat children and young people with the illness, using methods similar to those used in Australia.