The highest documented rates in the world of Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD) are found in Aboriginal Australians, Maori and Pacific Islander people in New Zealand and Pacific island nations. The only proven, cost-effective approach to controlling RHD is secondary prophylaxis, usually delivered via a register-based control program, such as commenced in the Top End of the NT in 1997, and in Central Australia in 2000.

These programs have been successful in identifying and registering new cases of RHD and providing medical and surgical care to people with RHD. However, most new patients entered onto the register already have significant rheumatic valvular lesions, often resulting in heart failure. The aim of register-based secondary prophylaxis programs is to prevent people with ARF/RHD developing heart failure in the first place, or having their heart failure worsen to the point that it is life threatening or requires medical or surgical intervention. The major challenge is to identify people with RHD early in the natural history of the illness, when most cases are asymptomatic, so that preventive measures can be instituted when they are likely to have the greatest effect. It is known that secondary prophylaxis delivered to people with mild RHD results in the vast majority having no detectable disease 5 to 10 years later.

This project will determine the prevalence of previously undetected RHD and whether it varies between jurisdictions. It will also evaluate the feasibility and cost-effectiveness of different approaches to screening, and develop a model for ongoing screening that can be incorporated into State and Territory RHD programs.

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