RHEUMATIC HEART DISEASE Kathy Brown Senior Director Aboriginal and Torres Strait Islander Health Branch Queensland Health RHEUMATIC HEART DISEASE A plan of action for Queensland “While acute rheumatic fever has become a rare curiosity in Australia’s non-Indigenous population, its incidence in Indigenous Australians living in remote areas remains among the highest reported in the world. It is unlikely that such a stark contrast between two populations living within the same national borders exists for any other disease or on any other continent.” – Alex Brown, Malcolm McDonald, Tom Calma

The Rheumatic Heart Disease pathway Diagnosis should be based on assessment of symptoms combined with clinical history. Rheumatic Heart Disease occurs when untreated, recurrent ARF episodes cause heart valve damage. Recurrence rate of ARF is greatest in first year after first episode. Social determinants such as poor living conditions are key drivers for onset of ARF and RHD. Acute Rheumatic Fever is an autoimmune response to a group A streptococcus (GAS) bacterial infection. Misdiagnosis occurs due to complexity of diagnosis may result in delayed or no treatment. Symptoms such as fever, joint pain, sore throats and rashes are non-specific to the infection.

Queensland CVD Burden by condition, age and Indigenous status (2011) Acute Rheumatic Fever and Rheumatic Heart Disease in Queensland Queensland CVD Burden by condition, age and Indigenous status (2011) 88 percent The proportion of ARF notifications (total 1,151) for Indigenous Queenslanders (1,018) between 1999 and 2017 12 years The median age for onset of ARF for both Indigenous and non-Indigenous Queenslanders RHD Register data Indigenous Non-Indigenous 169 times The prevalence rate of RHD for Indigenous Australians compared with non-Indigenous Australians at December 2015 1,055 The number of Indigenous Queenslanders with RHD currently listed on the Queensland RHD Register at July 2017

National Queensland Rheumatic Heart Policy Framework Rheumatic Fever Strategy (2009) – State-based register and control programs; education and training resources; data collection. Evaluation of the RHS (2017) – Support an increased awareness of ARF and RHD among Aboriginal and Torres Strait Islander Queenslanders. National Partnership Agreement on Rheumatic Fever Strategy (2017-18) – Commonwealth funding continued for three years (2017–18 to 2020–21). Queensland Queensland RHD Register and Control Program – State-based register and recall system, improved clinical care, education and training, data collection. Queensland Aboriginal and Torres Strait Islander Rheumatic Heart Disease Action Plan 2018–2021

$4.5 million (over 3 years from 2018-19) Rheumatic Heart Disease Action Plan 2018-2021 $4.5 million (over 3 years from 2018-19) New funding has been earmarked for activities under the RHD Action Plan: Support an increased awareness of ARF and RHD among Aboriginal and Torres Strait Islander Queenslanders Increased education for communities and clinicians on identifying the early symptoms of ARF and the important of early treatment Foster clinical knowledge on ARF and RHD across the health workforce, to support early diagnosis and treatment Enhance the Queensland RHD Register and Control Program to enable stronger linkages with acute cardiology services.

Priorities under the RHD Action Plan Promote, prevent, empower Ensure patients have the information they need and enable them to make the best decisions on their health. Improve the patient experience Provide patients with a comfortable clinical experience, coordinated streamlined service delivery and positive engagement with health care providers. Strengthen the approach Work cohesively to establish new relationships and partnerships with health service providers, and build on existing ones. Foster clinical knowledge Enable health professionals to appropriately prevent, diagnose and manage ARF and RHD. Enhance the Queensland RHD Register and Control Program Enable the Register to fully meet the needs of patients, other stakeholders and the requirements of the Rheumatic Fever Strategy and the Action Plan.

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