Long-Term Outcomes From Acute Rheumatic Fever and Rheumatic Heart Disease: A Data-Linkage and Survival Analysis Approach

Autor: John R. Condon, Yuejen Zhao, Jonathan R. Carapetis, Vincent Y. F. He, Keith Edwards, Jessica L. de Dassel, Bart J. Currie, Kathryn Roberts, Anna P. Ralph, Marea Fittock
Rok vydání: 2015
Předmět:
Male
Native Hawaiian or Other Pacific Islander
Heart disease
heart failure
Comorbidity
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
survival analysis
0302 clinical medicine
Recurrence
Original Research Articles
Atrial Fibrillation
030212 general & internal medicine
Renal Insufficiency
Child
Endocarditis
Smoking
Atrial fibrillation
Middle Aged
3. Good health
Hospitalization
Stroke
Alcoholism
Treatment Outcome
Child
Preschool
Acute Disease
Cardiology
Disease Progression
Rheumatic fever
Female
Rheumatic Fever
Cardiology and Cardiovascular Medicine
Adult
medicine.medical_specialty
Adolescent
complications
White People
03 medical and health sciences
Young Adult
Physiology (medical)
Internal medicine
medicine
Northern Territory
Humans
Survival analysis
Aged
Proportional Hazards Models
Proportional hazards model
business.industry
Rheumatic Heart Disease
Infant
medicine.disease
alcohol drinking
Heart failure
business
Follow-Up Studies
Zdroj: Circulation
ISSN: 1524-4539
Popis: Background: We investigated adverse outcomes for people with acute rheumatic fever (ARF) and rheumatic heart disease (RHD) and the effect of comorbidities and demographic factors on these outcomes. Methods: Using linked data (RHD register, hospital, and mortality data) for residents of the Northern Territory of Australia, we calculated ARF recurrence rates, rates of progression from ARF to RHD to severe RHD, RHD complication rates (heart failure, endocarditis, stroke, and atrial fibrillation), and mortality rates for 572 individuals diagnosed with ARF and 1248 with RHD in 1997 to 2013 (94.9% Indigenous). Results: ARF recurrence was highest (incidence, 3.7 per 100 person-years) in the first year after the initial ARF episode, but low-level risk persisted for >10 years. Progression to RHD was also highest (incidence, 35.9) in the first year, almost 10 times higher than ARF recurrence. The median age at RHD diagnosis in Indigenous people was young, especially among males (17 years). The development of complications was highest in the first year after RHD diagnosis: heart failure incidence rate per 100 person-years, 9.09; atrial fibrillation, 4.70; endocarditis, 1.00; and stroke, 0.58. Mortality was higher among Indigenous than non-Indigenous RHD patients (hazard ratio, 6.55; 95% confidence interval, 2.45–17.51), of which 28% was explained by comorbid renal failure and hazardous alcohol use. RHD complications and mortality rates were higher for urban than for remote residents. Conclusions: This study provides important new prognostic information for ARF/RHD. The residual Indigenous survival disparity in RHD patients, which persisted after accounting for comorbidities, suggests that other factors contribute to mortality, warranting further research.
Databáze: OpenAIRE
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