Australia has one of the highest reported rates of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in the world. 

Globally, there are at least 15.6 million people with RHD, and annually, over 230 000 people die from the disease. It is estimated that there are another 1.9 million people who have had ARF and 470 000 new cases are diagnosed every year. These figures are likely to be an underestimate of the true global burden of the disease.

Some of the highest rates of ARF and RHD in the world are found among Indigenous Australians (particularly across central and northern Australia), New Zealand Māori, and other Pacific Island populations. The prevalence of RHD is also high in sub-Saharan Africa, Latin America, the Indian subcontinent, the Middle East and Northern Africa.

In Australia, Aboriginal and Torres Strait Islander peoples are up to eight times more likely than other Australians to be hospitalised, and nearly 20 times more likely to die from this disease.

ARF can develop after an immunological response to group A streptococcal (Strep A) infection. If not diagnosed and treated, ARF can lead to permanent heart valve damage, a condition known as RHD. Community rates of ARF and RHD are known to reduce with improved housing, decreased household crowding, and access to appropriate health services and antibiotics to treat group A streptococcal infections and prevent recurrent ARF.

RHD is the most common worldwide cause of heart-related death in children and adults aged under 40 years. However, through simple and cost-effective strategies, RHD and associated deaths can be prevented.

Menzies researchers work with high-risk populations across Australia and the Pacific region to better understand and manage the factors that drive ARF and RHD.

Our research focus:
  • To test whether a model of care designed to optimise health systems and community resources improves adherence to secondary prophylaxis for ARF
  • To understand why ARF progresses to RHD in some people. Many people will experience group A streptococcus infections but only some will develop RHD. Launched in 2012, RHD Genetics is a collaborative study investigating the role genetics plays in the presence and progression of ARF and RHD
  • To develop a sustainable model of detecting RHD by training local non-expert practitioners using echo-screening in remote health clinics in northern Australia and Timor-Leste.  This study will provide guidance for other communities and remote health clinics, providing information on what may help and what may hinder implementation.
  • To determine the impact a diagnosis of RHD has on the lives of young people living in communities
  • To quantify the level of heart inflammation in First Nations people diagnosed with AFT and RHD
  • To provide an evidence base on which to improve clinical care and health 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 that people can receive treatment as soon as possible
  • Supporting RHD Guideline updates in Australia and Timor-Leste
  • 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.
RHD Guidelines:
The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart, and associated resources (including the e-learning modules, and ARF/RHD diagnosis/calculator application), are maintained at Menzies School of Health Research. These resources are freely available via