Rheumatic Heart Disease Prophylaxis in Older Patients: A Register-Based Audit of Adherence to Guidelines
James V Holland1, Kate Hardie2, Jessica de Dassel2,3
1MBBS, Monash University, Melbourne, Victoria, Australia.
Open Forum Infectious Diseases
|June 27, 2018
Summary
Stopping antibiotic prophylaxis for rheumatic heart disease (RHD) in adults over 35 is often not aligned with guidelines. Timely specialist reviews are key to improving appropriate discontinuation and reducing patient and health system burden.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Cardiology
Background:
- Rheumatic heart disease (RHD) prevention is a global health challenge, particularly in high-burden regions.
- Secondary antibiotic prophylaxis after acute rheumatic fever (ARF) is crucial for RHD prevention.
- Current international guidelines offer differing recommendations on prophylaxis duration, allowing for clinical discretion, and timely cessation is often not well-documented.
Purpose of the Study:
- To audit the appropriateness of antibiotic prophylaxis cessation in adults aged 35 years and older in Australia's Northern Territory.
- To assess concordance with national guidelines for secondary antibiotic prophylaxis in RHD patients.
Main Methods:
- A register-based audit was conducted using data from clients aged 35 years and older in Australia's Northern Territory.
- Data extracted included demographics, ARF history, RHD severity, and prophylaxis details.
- Guideline concordance was determined based on adherence to national guidelines, documented reasons for departure, and consideration of lifelong prophylaxis for severe RHD.
Main Results:
- Of 343 clients aged ≥35 years on prophylaxis, guideline concordance was 39% (national guidelines), 68% (with documented departures), and 82% (including potential lifelong cases).
- Shorter intervals since last echocardiogram or cardiologist review correlated with higher guideline concordance (P < .001).
- Median time since last ARF was significantly shorter in the guideline-concordant group (5.9 years) compared to the nonconcordant group (24.0 years), with 32 individuals experiencing ARF after age 40.
Conclusions:
- Appropriate discontinuation of RHD prophylaxis in this population could be enhanced.
- Implementing timely specialist reviews is recommended to optimize prophylaxis cessation.
- This strategy aims to reduce the unnecessary burden on both patients and healthcare systems.
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