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:
- We established RHDAustralia in 2009 as the National Coordination Unit to support control of RHD in Australia. Funded by the Australian Department of Health and Ageing Rheumatic Fever Strategy, RHDAustralia was an initiative of Menzies, Baker IDI and James Cook University. RHDAustralia is based at Menzies
- 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
- Developed Ipad, iPhone and Android applications for clinicians based on the latest diagnosis and management guidelines
- 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.
- 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
Key rheumatic heart disease staff:
- Bart Currie, Director RHD Australia
- Anna Ralph
- Steven Tong
- Bo Remenyi
- Melita McKinnon
- Jessica de Dassel
- Kylie Tune
- Samantha Colquhoun
Key RHD Australia staff:
- 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).
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.