Surgical and percutaneous management of Aboriginal Australians with rheumatic heart disease: Timeliness and concordance between practice and guidelines

Rheumatic heart disease (RHD) affects over 40 million people globally who are predominantly young and from impoverished communities. The barriers to valvular intervention are complex and contribute to the high morbidity and mortality associated with RHD. The rates of guideline indicated intervention...

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Bibliographic Details
Published in:International journal of cardiology 2021-07, Vol.335, p.80-84
Main Authors: Roberts-Thomson, Ross L., Baumann, Angus A.W., Reade, Julie, Culgan, Libby, Kaethner, Alex, Ilton, Marcus, Kangaharan, Nadarajah, Tayeb, Hussam M., Sinhal, Ajay, Chew, Derek P., Bennetts, Jayme S., Nicholls, Stephen J., Psaltis, Peter J., Brown, Alex
Format: Article
Language:English
Subjects:
Adult
Australia - epidemiology
Female
Heart Valve Diseases
Humans
Male
Middle Aged
Mitral Valve
Rheumatic Heart Disease - diagnostic imaging
Rheumatic Heart Disease - surgery
Young Adult
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Summary:Rheumatic heart disease (RHD) affects over 40 million people globally who are predominantly young and from impoverished communities. The barriers to valvular intervention are complex and contribute to the high morbidity and mortality associated with RHD. The rates of guideline indicated intervention in patients with significant RHD have not yet been reported. From 2007 to 2017, we used the Australian Northern Territory Cardiac Database to identify patients with RHD who fulfilled at least one ESC/EACTS guideline indication for mitral valve intervention. Baseline clinical status, comorbidities, echocardiographic parameters, indication for intervention, referral and any interventions were recorded. 154 patients (mean age 38.5 ± 14.6, 66.1% female) were identified as having a class I or IIa indication for invasive management. Symptoms, atrial fibrillation and pulmonary hypertension were the most common indications for surgery (74.5%, 48.1%, 40.9%). From the onset of a guideline indication the actuarial rates of accepted referral and intervention within two-years were 66.0% ± 4.0% and 53.1% ± 4.4% respectively. Of those who were referred and accepted for intervention, 86% received it within 2 years. The rates of accepted referral for patients with class I indications were 72.5% ± 4.2% while class IIa indications were 42.5% ± 9.0% (p
ISSN:0167-5273
1874-1754
1874-1754
DOI:10.1016/j.ijcard.2021.04.030