About Rheumatic heart disease

A preventable disease of disparity
 

What is Rheumatic Heart Disease (RHD)?

Legs with skin soresRheumatic heart disease is a permanent form of heart damage, caused by an abnormal reaction to a Strep A infection. Those most at risk of developing the disease are young Indigenous Australians aged 5-15.

Boy having a mouth swabThe path to RHD begins with a sore throat or skin infection. If not treated with antibiotics, some young people will go on to develop acute rheumatic fever (ARF) some weeks later. ARF causes sore joints, high fevers, and inflammation of the heart.

While the other symptoms of acute rheumatic fever pass after time, the heart damage remains. It’s this permanent heart damage that is known as rheumatic heart disease.

People living with RHD

If you’re looking for resources to learn more about living with rheumatic heart disease, or how you can best support someone who is, head to the RHDAustralia website to learn more.

How many people living in Australia have RHD?

It’s hard to get an exact figure for the number of people living with RHD in Australia. We know at least 6,000 people are currently receiving care for rheumatic heart disease or acute rheumatic fever (almost all of them Indigenous) – but the actual number is likely to be considerably higher.

Despite the fact that RHD is preventable, 400,000 people in Australia are thought to be at risk of getting the disease. Most of these are Aboriginal or Torres Strait Islander Australians.

How is it diagnosed and managed?

Doctor and patientIt’s important to note that there is no cure for rheumatic heart disease, although the path towards the disease can be interrupted at different times. Ideally, we would reduce the amount of Strep A that people are exposed to – by reducing household crowding and making living environments healthier and cleaner. This is called concentrating on the social determinants of health (sometimes called primordial prevention).

In the early stages, Strep A infections can be diagnosed and treated, preventing the development of acute rheumatic fever and RHD. This is called primary prevention.

Once someone has developed ARF or early RHD, they can be given regular antibiotic injections to stop further Strep A throat or skin infections, and prevent heart valve damage getting worse. This means a young person diagnosed with ARF needs an injection every 21 to 28 days for at least ten years. This is called secondary prevention.

Without this treatment, people with RHD may end up with heart failure, needing heart surgery. Surgery does not cure RHD and people living with advanced RHD need a lifetime of medical care and follow up.

Tragically, many Aboriginal and Torres Strait Islander Australians die of the disease in their 40s.

Why are Aboriginal and Torres Strait Islander people at such high risk of RHD?

Aboriginal and Torres Strait Islander Australians live with some of the highest rates of Strep A infection, ARF and RHD in the world – caused by very high exposure to Strep A in young children.

Infection with this germ occurs frequently in crowded living environments, and houses with inadequate health hygiene facilities. Diagnosis and treatment of these frequent infections is difficult for many Aboriginal and Torres Strait Islander people who face practical, economic and cultural barriers to accessing health care.

Poverty and inequality may also contribute to the high rates of RHD. Genetic studies in Australia and internationally have not shown that Indigenous people are inherently more susceptible to the disease, although individuals in any population are genetically more likely than others to develop rheumatic fever or rheumatic heart disease. Around the world, economic development, improved living conditions and access to health care have reduced the rate of rheumatic fever in communities which previously had a high rate of the disease.

For this reason, RHD can be considered a disease of social disadvantage which can be reduced by improving the social and economic environments where people live, learn and work.

Another lens to Close the Gap

Rheumatic heart disease is the leading cause of cardiovascular inequality in Australia, and continues to contribute to the gap in life expectancy and quality of life between Aboriginal & Torres Strait Islander and non-Indigenous Australians.

Because tackling RHD involves collective action to deal with poverty, inequality, overcrowding, inadequate housing, and lack of access to suitable hygiene facilities, we know that addressing the disease will in turn, have positive outcomes for a range of other diseases, such as ear disease, pneumonia, scabies and gastroenteritis.

Rheumatic heart disease is a specific, measurable goal for closing the gap, and one deserving of more attention when looking at inequality between Indigenous and non-Indigenous Australians more broadly.

 

All illustrations credited to Kimberley Aboriginal Medical Services Ltd (KAMS)