The Impact of Acute Rheumatic Fever Diagnosis on Rheumatic Heart Disease Severity

Acute rheumatic fever (ARF) is the precursor to rheumatic heart disease (RHD) following Group A Streptococcal infection. However, many diagnoses of RHD are made in the absence of ARF history. We compared RHD severity between those with and those without a documented history of ARF.

A retrospective audit of echocardiographic images determined RHD stage at diagnosis and at follow-up based on the 2023 WHF guidelines for the diagnosis of RHD.Individuals aged ≤ 20 years from the Top End of the Northern Territory (NT) of Australia with RHD diagnosis between January 2012 and December 2021 were included.Primary outcome was RHD stage at the time of diagnosis. Secondary outcomes were RHD stage progression or regression. Those with ARF and those with no ARF (noARF) were compared.

Study population (n) of 292 individuals with mean age 11.9 ± 3.8 years. At baseline, the ARF group had more Stage A RHD (28.6% versus 12.0%), while the noARF group had more Stage B (50.0% versus 38.0%), p = 0.009. There was no difference in advanced RHD (Stage C and D combined) between the groups (p = 0.440). Follow-up (median 46 months, IQR: 27-71 months) sample size was 230. Regression of RHD was greater in the ARF group (46% versus 28%, p = 0.014). No difference was found in stage progression (including to surgery), with 21% (32/156) in the ARF group and 15% (11/74) in the noARF group (p = 0.367).

Individuals at all stages of RHD severity were detected amongst those with and without an accompanying diagnosis of ARF. Individuals with first RHD diagnosis accompanied by ARF were more likely to regress. These findings support echocardiographic screening in high-risk populations to detect early RHD that can be treated with secondary antibiotic prophylaxis. Further research is required to understand the reason for differences between the ARF and noARF groups.