Katherine Kang 

Dr Kang is a Basic Physician Trainee working at Cairns Base Hospital. She graduated from Queen’s University Belfast, previously trained in United Kingdom before continuing her journey in Australia. She is currently involved in cardiology-related research projects and is enthusiastic to continue broadening her experience in clinical research.

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The Temporospatial Epidemiology of Rheumatic Heart Disease in Far North Queensland (1997-2017)

Aims:  
Rheumatic Heart Disease (RHD) is a preventable but major cause of cardiovascular disease globally. It is essential to define the temporospatial epidemiology of the disease to inform local prevention strategies.

Methods:  
This retrospective study was conducted in Far North Queensland (FNQ) in tropical Australia.  Individuals diagnosed with RHD in between 1997 and 2017 were identified using the Queensland RHD Register and their clinical course defined using public health system data.

Results:  
There were 686 individuals diagnosed with RHD during the study period. Their median age at diagnosis was 29 (interquartile range (IQR) 17-44) years; 458 (66.8%) were female; 616 (89.8%) identified as Indigenous Australians. The incidence of RHD increased from 4.7/100000/year in 1997 to 49.4/100000/year in 2017 (p<0.001). RHD incidence increased in both metropolitan and rural and remote locations, but in 2017 it was significantly higher in rural and remote settings (median (IQR) 44.6/100000/year (20.3-90.7) than in metropolitan locations (5.9/100000/year (1.3-10.4), p<0.001). Adherence data for patients receiving prophylaxis were available from 2007, 388 individuals with RHD were prescribed secondary prophylaxis: parenteral penicillin in 367 (95%) and oral therapy in 21 (5%). The median (IQR) adherence to parenteral secondary prophylaxis was 41% (23-58%). Only 7/367 (1.9%) patients achieved good adherence (defined as >80% doses in >80% of years of prescribed therapy). The number of individual RHD patients requiring valve surgery increased from 52 (42%) between 1997-2007 to 72 (58%) between 2008-2017 (p=0.03). 

Conclusions:  
The incidence of RHD and RHD-related surgery continues to rise in FNQ. Although this is likely to be at least partly explained by increased disease recognition and enhanced service delivery, RHD incidence remains unacceptably high and is disproportionately borne by the Indigenous population, particularly in rural and remote locations. Improved primary and secondary prophylaxis are urgently required to reduce the burden of this preventable disease.