Lexi Webster
Australia has one of the highest reported rates of rheumatic heart disease (RHD) in the world. The disease is preventable and treatable, but it is a leading cause of death among young Indigenous Australians. RHD is caused by permanent damage to the heart valves as a result of acute rheumatic fever (ARF). In 2023, there were 11,136 people living with a diagnosis of ARF and/or RHD recorded in New South Wales, Queensland, Western Australia, South Australia and the Northern Territory. Of these, 3,361 people (30%) had only RHD recorded. First Nations people accounted for 91% of ARF diagnoses and 81% of all ARF and RHD cases.
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What You'll Learn
First Nations people are disproportionately affected by RHD
Rheumatic heart disease (RHD) is a serious condition that causes permanent damage to the heart muscle or heart valves. It is the result of an autoimmune response to a Strep A bacterial infection, which causes undesirable inflammation, known as acute rheumatic fever (ARF). RHD can cause severe incapacity or even death.
First Nations people in Australia are disproportionately affected by RHD. They experience the disease at far higher rates than non-Indigenous Australians. In 2023, First Nations people accounted for 81% of people living with ARF and/or RHD recorded on the registers in New South Wales, Queensland, Western Australia, South Australia, and the Northern Territory. This is despite First Nations people making up only around 3% of the total Australian population. The number and rate of diagnoses among First Nations people increased from 46.2 per 100,000 in 2013 to 67.8 per 100,000 in 2023. In 2023, 282 new RHD diagnoses were reported among First Nations people, with a rate of 56.3 per 100,000. The median age among First Nations people with RHD was 33.3 years, much lower than the median age of 65.4 years for non-Indigenous Australians.
First Nations females are particularly affected by RHD, with higher rates of diagnosis and hospitalisation than First Nations males. In 2023, new RHD diagnoses were more common among First Nations females, with a rate of 72.7 per 100,000, compared to 39.9 per 100,000 for males. In 2022, ARF and RHD hospitalisations among First Nations females were eight times higher than the non-Indigenous rate, compared to five times higher for First Nations males.
The high rates of RHD among First Nations people are linked to underlying social disadvantage and environmental conditions, including factors such as housing, healthcare access, and socioeconomic status. First Nations people often face barriers to accessing healthcare, including cost, availability of travel, and the need to spend extended periods away from home. They are also more likely to experience social disadvantages such as household overcrowding.
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RHD is preventable and treatable
Rheumatic heart disease (RHD) is a serious condition that affects many people in Australia, particularly those from Indigenous and First Nations communities. It is a preventable and treatable disease, and addressing it effectively can reduce the risk of long-term health complications and death.
Firstly, RHD is preventable through early treatment of the underlying causes, primarily strep throat infections caused by group A Streptococcus bacteria. Penicillin and other antibiotics can effectively treat these infections and prevent the development of acute rheumatic fever, which is the precursor to RHD. Early detection and treatment of strep throat are crucial, as untreated infections can have severe consequences, including RHD. Antibiotics provided within the first nine days of infection can reduce the risk of progression to acute rheumatic fever by 70-80%. For those who have already had rheumatic fever, long-term antibiotic treatments, such as benzathine penicillin G injections every 3–4 weeks, can prevent future episodes and reduce the risk of further heart damage.
Secondly, RHD is treatable, although advanced stages may require long-term care and surgery to repair or replace damaged heart valves. However, with timely treatment of rheumatic fever, the risk of progressing to severe RHD can be significantly reduced. Additionally, community-centred efforts, such as increasing awareness of infection symptoms and improving access to resources like soap and water for handwashing, can play a vital role in preventing and treating RHD.
In Australia, the high burden of RHD among Indigenous and First Nations communities has been recognised, with rates up to 60 times higher than those of non-Indigenous Australians. This disparity highlights the need for increased investment in tackling the social determinants of the disease, improving access to healthcare, and actively finding and screening undiagnosed cases in these communities.
While deaths from RHD in Australia are uncommon, the disease continues to impact the lives of many, especially in disadvantaged communities. By focusing on prevention through early infection treatment and management of rheumatic fever, as well as ensuring equitable access to healthcare services, the incidence and impact of RHD can be significantly reduced.
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RHD is caused by damage to the heart valves
Rheumatic heart disease (RHD) is a condition where the heart valves have been permanently damaged by rheumatic fever. This can occur when an untreated or undertreated streptococcal infection triggers an abnormal immune response, causing inflammation throughout the body, including in the heart. This inflammatory disease can affect many connective tissues, especially in the heart, joints, skin, or brain.
The heart valve damage may start shortly after a strep infection, such as strep throat or scarlet fever, and can lead to ongoing valve damage. The heart valves can become inflamed and scarred over time, resulting in narrowing or leaking of the heart valve. This makes it harder for the heart to function normally, as the damage reduces the heart's ability to pump blood effectively around the body. As a result, people with RHD may experience symptoms such as shortness of breath, fatigue, weakness, and chest pain.
RHD is typically diagnosed through a physical examination, which may reveal a heart murmur or rub caused by blood leaking around the damaged valve. An echocardiogram is the most useful test for diagnosing heart valve problems, as it uses sound waves to create a detailed image of the heart's chambers and valves, allowing for the detection of valve damage, backflow of blood, fluid around the heart, and heart enlargement.
In terms of treatment, medication and surgery are the main options, although there is currently no cure for RHD. Surgery may be required when the mitral or aortic valve is severely damaged, and it typically involves replacing or fixing the damaged valve. Preventing strep infections through improved living conditions and access to antibiotics is crucial for preventing RHD, especially in high-risk populations.
In Australia, Aboriginal and Torres Strait Islander peoples are up to 60 times more likely to live with RHD than non-Indigenous Australians, and they are nearly 20 times more likely to die from the disease. As of December 31, 2023, there were 11,136 people living with a diagnosis of acute rheumatic fever (ARF) and/or RHD recorded in several Australian states and territories, with 3,361 people having only RHD recorded. Additionally, in 2021-22, there were 4,700 hospitalisations with a principal diagnosis of ARF or RHD, and the rate of hospitalisations has been increasing over the years.
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RHD is one of the leading causes of death among young Indigenous people
Rheumatic heart disease (RHD) is permanent damage to the heart muscle or heart valves, which reduces the heart's ability to pump blood effectively around the body. This can lead to severe symptoms such as shortness of breath, fatigue, and weakness. RHD is one of the leading causes of death among young Indigenous people in Australia.
Indigenous Australians, particularly those in central and northern Australia, have some of the highest rates of RHD in the world. Aboriginal and Torres Strait Islander peoples are up to 15 times more likely to be diagnosed with RHD than non-Indigenous Australians. This disparity is even more pronounced in children, with Aboriginal children aged 5 to 15 years being 55 times more likely to die from RHD than other Australian children.
The high rates of RHD among Indigenous Australians are driven by several factors. Firstly, skin infections caused by Group A streptococcus are prevalent among Aboriginal and Torres Strait Islander children, and these infections are a known cause of RHD. Additionally, impoverished living conditions and untreated infections have been identified as contributing factors to the high burden of RHD in these communities.
The impact of RHD on Indigenous Australians is further exacerbated by challenges in diagnosis and treatment. RHD symptoms can occur with other heart conditions, making diagnosis more difficult. Furthermore, there has been a decline in the proportion of First Nations people receiving their prescribed treatments, possibly due to the COVID-19 pandemic's impact on healthcare access.
Addressing the high rates of RHD among Indigenous young people in Australia requires a multifaceted approach. This includes improving prevention and management strategies, adopting decolonizing approaches that address the historical and societal factors contributing to the issue, and ensuring equitable access to healthcare and treatment for Indigenous communities.
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RHD disproportionately affects Indigenous women
Rheumatic heart disease (RHD) is a permanent heart damage condition resulting from a throat or skin infection caused by Group A. It reduces the heart's ability to pump blood effectively around the body, leading to symptoms such as shortness of breath, fatigue and weakness. While deaths from RHD are uncommon in Australia, the disease is almost entirely preventable and is considered a "national failure" due to its link to impoverished living conditions and untreated infections.
In Australia, RHD disproportionately affects Indigenous women, with First Nations people accounting for 95% of the 533 notifications of acute rheumatic fever (ARF) in 2022. The rate of ARF among First Nations people was 64 per 100,000 population, compared to 2.9 per 100,000 for non-Indigenous Australians. The disparity is even greater for Indigenous women, who experience ARF at a rate of 82.5 per 100,000, compared to 53.0 per 100,000 for Indigenous men.
The high rates of RHD among Indigenous Australians, particularly women, are linked to socioeconomic disadvantage and a lack of access to healthcare. In Far North Queensland, the incidence of RHD has been rising, with the burden of disease falling almost entirely on the region's Indigenous population. Patients in socioeconomically disadvantaged areas are more likely to have RHD and are also less likely to receive the surgery needed to address advanced disease.
The Australian Medical Association has emphasised the need to address the social determinants of health, such as impoverished living conditions, that contribute to the high rates of RHD among Indigenous communities. Racism and discrimination against Aboriginal and Torres Strait Islander people further exacerbate health inequalities, with a third of Indigenous Australians reporting unfair treatment due to their ethnicity.
To address the disproportionate impact of RHD on Indigenous women, a multi-faceted approach is necessary. This includes improving access to healthcare and surgery, addressing social determinants of health such as poverty and racism, and working in partnership with Indigenous communities to develop preventative strategies that consider personal, community and environmental factors.
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Frequently asked questions
Australia has one of the highest reported rates of RHD in the world. In 2023, there were 7,192 Australians living with RHD recorded in Queensland, Western Australia, South Australia, and the Northern Territory.
In 2021-22, there were 4,700 hospitalizations with a principal diagnosis of RHD, accounting for 0.8% of all cardiovascular disease hospitalizations, or 18 hospitalizations per 100,000 population.
First Nations people are significantly more affected by RHD than non-Indigenous Australians. In 2023, First Nations people accounted for 81% of the 11,136 people living with a diagnosis of RHD recorded in five jurisdictions.
The Northern Territory has one of the highest known rates of RHD in the world. In 2015-2017, the Northern Territory had the highest hospitalization rate for RHD among the five jurisdictions, with 481 per 100,000.
Deaths from RHD are uncommon in Australia. In 2022, RHD was the underlying cause of 350 deaths, representing 0.2% of all deaths and equivalent to 1.3 deaths per 100,000 population.
