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The Impact of Acute Rheumatic Fever Diagnosis on Rheumatic Heart Disease Severity.
Jacqueline Maree Williamson1, Gillian Whalley2, Simon Thornley3
1Menzies School of Health Research, Charles Darwin University, Australia.
Global Heart
|September 2, 2025
Summary
Rheumatic heart disease (RHD) can occur without a history of acute rheumatic fever (ARF). Individuals diagnosed with ARF showed a higher likelihood of RHD regression, highlighting the importance of early detection and intervention.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Acute rheumatic fever (ARF) precedes rheumatic heart disease (RHD) after Group A Streptococcal infections.
- Many RHD diagnoses lack a documented ARF history, necessitating comparison of RHD severity between these groups.
- This study investigates RHD progression and regression in individuals with and without a prior ARF diagnosis.
Purpose of the Study:
- To compare the severity and progression of rheumatic heart disease (RHD) in individuals with and without a documented history of acute rheumatic fever (ARF).
- To evaluate RHD stage at diagnosis and follow-up using the 2023 World Heart Federation guidelines.
- To identify differences in RHD regression and progression rates between ARF and no-ARF cohorts.
Main Methods:
- Retrospective audit of echocardiographic images for 292 individuals (≤20 years) diagnosed with RHD in Northern Territory, Australia (2012-2021).
- RHD staging at diagnosis and follow-up (median 46 months) based on 2023 WHF guidelines.
- Comparison of RHD stage, progression, and regression between individuals with ARF history and those without (noARF).
Main Results:
- At diagnosis, the ARF group had more Stage A RHD (28.6% vs 12.0%), while the noARF group had more Stage B (50.0% vs 38.0%).
- No significant difference in advanced RHD (Stages C & D) was observed between groups (p=0.440).
- RHD regression was significantly greater in the ARF group (46% vs 28%, p=0.014), with no difference in stage progression (p=0.367).
Conclusions:
- Rheumatic heart disease (RHD) severity at diagnosis varies, with individuals with ARF history showing a higher likelihood of regression.
- Findings support echocardiographic screening in high-risk populations for early RHD detection and treatment with antibiotic prophylaxis.
- Further research is needed to elucidate the reasons behind the observed differences in RHD outcomes between ARF and noARF groups.
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