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Rheumatic Heart Disease A National (international) Perspective
Graeme Maguire Cairns Clinical School School of Medicine & Dentistry James Cook University
• What is it and what causes it
• How much is around (especially in women)
• Stopping it (especially as a problem in pregnancy)
• RHD in pregnancy
Rheumatic Heart Disease A National (international) Perspective
What is it Group A streptococcal infection
What is it Acute rheumatic fever
What is it Rheumatic heart disease
What is it Rheumatic heart disease
What is it Rheumatic heart disease
What causes it
What causes it
Under the right conditions a proportion of people in any population can be at risk of ARF/RHD
Population at risk
GAS colonization
GAS pharyngitis
ARF
RHD
Population at risk
GAS colonization
GAS pharyngitis
ARF
RHD
02000400060008000
1000012000140001600018000
Burden of disease (years of life lost (YLL) + years of life of disability (YLD) - Aboriginal &
Torres Strait Islander peoples - 2003
How much is around?
• Extremely rare overall
BUT •Aboriginal and Torres Strait Islander children (5-14 yo) highest documented rates in the world 250-300/100 000/yr (one case for every 300 kids every year)
• ½ million cases of ARF/yr globally
How much is around? Acute rheumatic fever
• Extremely rare overall BUT
• 1-2% of Aboriginal and Torres Strait Islander peoples
• 16 million people living with RHD globally
How much is around? Rheumatic heart disease
0
5
10
15
20
25
30
35
40
45
0 - 10 10 - 20 20 - 30 30 - 40 40 - 50 50 - 60 60 -70 70 -80 80 - 90
% o
f A
RF/
RH
D p
atie
nts
Age group (yrs)
FEMALES
MALES
How much is around? Rheumatic heart disease
How much is around? Why more in women?
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0 - 10 10 - 20 20 - 30 30 - 40 40 - 50 50 - 60 60 -70 70 -80 80 - 90 ALL
% o
f A
RF/
RH
D p
atie
nts
Age group (yrs)
MALES
FEMALES
• More GAS infection
• Accelerated disease
• Greater diagnosis/access
Because ARF/RHD is preventable and the consequences can be
severe
So why do we worry about a relatively rare condition?
Population at risk
GAS colonization
GAS pharyngitis
ARF
RHD
Stopping it
Stopping it
Population at risk
GAS colonization
GAS pharyngitis
ARF
RHD
Stopping it
• RHD is rarely a reason for not getting pregnant BUT planning (and possibly treatment) before pregnancy is the key
• Preventing it – primary and secondary prevention
• Fertility planning/contraceptive advice in women with RHD is EVERYONE’S business
• What is it and what causes it
• How much is around (especially in women)
• Stopping it (especially as a problem in pregnancy)
• RHD in pregnancy
Rheumatic Heart Disease A National (international) Perspective
Why’s it important to you?
How much is around? Rheumatic heart disease
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0 - 10 10 - 20 20 - 30 30 - 40 40 - 50 50 - 60 60 -70 70 -80 80 - 90 ALL
% o
f A
RF/
RH
D p
atie
nts
Age group (yrs)
MALES
FEMALES