Rheumatic heart disease in indigenous populations

Area of Science:

• Cardiology
• Public Health
• Indigenous Health

Background:

• Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) rates remain unacceptably high in Aboriginal people, Torres Strait Islanders, and Māori.
• These populations experience inequitable cardiac morbidity, including valve disease, heart failure, and reduced life expectancy, with significant social and economic impacts.

Purpose of the Study:

• To highlight the critical need for improved prevention and management strategies for ARF and RHD in Indigenous populations.
• To emphasize the importance of culturally sensitive approaches and community involvement in addressing these health disparities.

Main Methods:

• Review of current ARF/RHD registries and secondary prophylaxis programs in Australia and New Zealand.
• Analysis of surgical outcomes for rheumatic valvular disease, particularly valve repair versus replacement in Indigenous patients.
• Examination of social determinants of health impacting RHD prevalence.

Main Results:

• Existing registries and prophylaxis programs are insufficient and not universally applied.
• Valve repair is generally superior to valve replacement for rheumatic valvular disease, with specific considerations for pregnant women.
• Surgical outcomes require long-term follow-up, and designated units may improve care for Indigenous patients.

Conclusions:

• Effective ARF and RHD prevention requires addressing social determinants like poverty and improving housing, education, and employment.
• Culturally empathetic, community-involved strategies are mandatory for reducing RHD rates.
• Improved surveillance, universal secondary prophylaxis, and optimized surgical care are essential.