The use of cardiac valve procedures for rheumatic heart disease in Australia; a cross-sectional study 2002-2017

Pamela J Bradshaw; Hideo Tohira; James Marangou; Mark Newman; Bo Reményi; Vicki Wade; Christopher Reid; Judith M Katzenellenbogen

doi:10.1016/j.amsu.2020.11.055

The use of cardiac valve procedures for rheumatic heart disease in Australia; a cross-sectional study 2002-2017

Ann Med Surg (Lond). 2020 Nov 25:60:557-565. doi: 10.1016/j.amsu.2020.11.055. eCollection 2020 Dec.

Authors

Pamela J Bradshaw¹, Hideo Tohira¹, James Marangou², Mark Newman³, Bo Reményi⁴, Vicki Wade⁴, Christopher Reid⁵, Judith M Katzenellenbogen¹

Affiliations

¹ The School of Population and Global Health, The University of Western Australia, Australia.
² Fiona Stanley Hospital, 11 Robin Warren Drive Murdoch, WA, 6150, Australia.
³ Sir Charles Gairdner Hospital, Hospital Ave. Nedlands, WA, 6009, Australia.
⁴ Menzies School of Health Research, PO Box, 41096, Casuarina, NT, Australia.
⁵ The Centre for Research Excellence Centre of Clinical Research and Education, Curtin University, Hayman Rd. Bentley, WA, Australia.

Abstract

Background: Australia, although a high income economy, carries a significant burden of rheumatic heart disease (RHD). Acute rheumatic fever (ARF) and RHD are endemic in the Indigenous population. Immigrants from low/lower-income countries ('non-Indigenous high-risk') are also at increased risk compared with 'non-Indigenous low-risk' Australians. This study describes the utilisation of surgical and percutaneous procedures for RHD-related valve disease among patients aged less than 50 years, from 2002 to 2017.

Methods: A descriptive study using data from the 'End RHD in Australia: Study of Epidemiology (ERASE) Project' linking RHD Registers and hospital inpatient data from five states/territories, and two surgical databases. Trends across three-year periods were determined and post-procedural all-cause 30-day mortality calculated.

Results: A total of 3900 valves interventions were undertaken in 3028 procedural episodes among 2487 patients. Over 50% of patients were in the 35-49 years group, and 64% were female. Over 60% of procedures for 3-24 year-olds were for Indigenous patients. There were few significant changes across the study period other than downward trends in the number and proportion of procedures for young Indigenous patients (3-24 years) and 'non-Indigenous/low risk' patients aged ≥35 years. Mitral valve procedures predominated, and multi-valve interventions increased, including on the tricuspid valve. The majority of replacement prostheses were mechanical, although bioprosthetic valve use increased overall, being highest among females <35 years and Indigenous Australians. All-cause mortality (n = 42) at 30-days was 1.4% overall (range 1.1-1.7), but 2.0% for Indigenous patients.

Conclusions: The frequency of cardiac valve procedures, and 30-day mortality remained steady across 15 years. Some changes in the distribution of procedures in population groups were evident. Replacement procedures, the use of bioprosthetic valves, and multiple-valve interventions increased. The challenge for Australian public health officials is to reduce the incidence, and improve the early detection and management of ARF/RHD in high-risk populations within Australia.

Keywords: ANZSCTS, Australian & New Zealand Society of Cardiac & Thoracic Surgeons national cardiac surgery database; Bioprosthesis; CABG, coronary artery bypass surgery; Indigenous health; NT, Northern Territory; RHD; Rheumatic heart disease; SA, South Australia; Valve surgery.