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Title: Rheumatic Heart Disease Severity, Progression and Outcomes: A Multi-State Model.
Authors: Cannon, Jeffrey
Roberts, Kathryn
Milne, Catherine
Carapetis, Jonathan R
Affiliation: Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia..
NT Rheumatic Heart Disease Register, Centre for Disease Control, Darwin, Northern Territory, Australia..
Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia..
Issue Date: 2-Mar-2017
Citation: Journal of the American Heart Association 2017-03-02; 6(3)
Abstract: Rheumatic heart disease (RHD) remains a disease of international importance, yet little has been published about disease progression in a contemporary patient cohort. Multi-state models provide a well-established method of estimating rates of transition between disease states, and can be used to evaluate the cost-effectiveness of potential interventions. We aimed to create a multi-state model for RHD progression using serial clinical data from a cohort of Australian patients. The Northern Territory RHD register was used to identify all Indigenous residents diagnosed with RHD between the ages of 5 and 24 years in the time period 1999-2012. Disease severity over time, surgeries, and deaths were evaluated for 591 patients. Of 96 (16.2%) patients with severe RHD at diagnosis, 50% had proceeded to valve surgery by 2 years, and 10% were dead within 6 years. Of those diagnosed with moderate RHD, there was a similar chance of disease regression or progression over time. Patients with mild RHD at diagnosis were the most stable, with 64% remaining mild after 10 years; however, 11.4% progressed to severe RHD and half of these required surgery. The prognosis of young Indigenous Australians diagnosed with severe RHD is bleak; interventions must focus on earlier detection and treatment if the observed natural history is to be improved. This multi-state model can be used to predict the effect of different interventions on disease progression and the associated costs.
DOI: 10.1161/JAHA.116.003498
Type: Journal Article
Subjects: pediatric
rheumatic heart disease
Cardiac Valve Annuloplasty
Child, Preschool
Cohort Studies
Disease Progression
Follow-Up Studies
Heart Valve Prosthesis Implantation
Northern Territory
Rheumatic Heart Disease
Severity of Illness Index
Young Adult
Oceanic Ancestry Group
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