Long-Term Outcomes of Acute Rheumatic Fever in Young Queenslanders: A Retrospective Cohort Study Using Linked Data, 2001–2021

Abstract

Aim: The high burden of acute rheumatic fever (ARF), inflammatory precursor of rheumatic heart disease (RHD), persists among Indigenous communities. Contemporary evidence of outcomes following first-ever ARF in population-based samples are sparse internationally. We determined the probability and risk predictors of ARF progression in Queensland <35-year-olds during 2001–2021. Method: Linked RHD register, hospital and death data were used for this retrospective cohort analysis, incorporating ≤20 years follow-up. First-ever ARF episodes were identified, and survival methods used to estimate probabilities and risk predictors of progression to ARF recurrence, any RHD and complicated RHD (heart failure, stroke, endocarditis, atrial fibrillation). We also examined the subset of outcomes following first-ever ARF diagnosed concurrently with RHD. Results: First-ever ARF was identified (n=1,570, 84% Indigenous, 52% female, 59% 5–14 years, 25% very remote), incorporating n=582 (37%) concurrent ARF/RHD. Within 15 years of first-ever ARF-only, 24.1% experienced ARF recurrence, 53.4% experienced RHD and 11.6% experienced RHD-associated complications. Comparatively, 27.4% developed RHD-associated complications within 15 years of concurrent ARF/RHD (Table). Major risk predictors of progression to RHD from ARF-only were age <15 years (HR=2.55) compared to 15–25 years and confirmatory echocardiogram later than 8 weeks of ARF diagnosis (HR=1.39) compared to within 4 weeks. For concurrent ARF/RHD, metro-southeastern hospital service (HR=2.23) was a risk predictor for progression to RHD-associated complications compared to health services in the far north. Conclusions: Over one-third of first-ever ARF were ARF/RHD diagnoses and over half of first-ever ARF-only diagnoses progressed to RHD within 15 years. Comprehensive follow-up following first-ever ARF is needed to prevent progression to RHD. [Formula presented]