Rheumatic Heart Disease - RANZCOG · Rheumatic Heart Disease . A National (international)...

Rheumatic Heart Disease A National (international) Perspective

Graeme Maguire Cairns Clinical School School of Medicine & Dentistry James Cook University

• What is it and what causes it

• How much is around (especially in women)

• Stopping it (especially as a problem in pregnancy)

• RHD in pregnancy

Rheumatic Heart Disease A National (international) Perspective

What is it Group A streptococcal infection

What is it Acute rheumatic fever

What is it Rheumatic heart disease

What is it Rheumatic heart disease

What is it Rheumatic heart disease

What causes it

What causes it

Under the right conditions a proportion of people in any population can be at risk of ARF/RHD

Population at risk

GAS colonization

GAS pharyngitis

ARF

RHD

Population at risk

GAS colonization

GAS pharyngitis

ARF

RHD

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Burden of disease (years of life lost (YLL) + years of life of disability (YLD) - Aboriginal &

Torres Strait Islander peoples - 2003

How much is around?

• Extremely rare overall

BUT •Aboriginal and Torres Strait Islander children (5-14 yo) highest documented rates in the world 250-300/100 000/yr (one case for every 300 kids every year)

• ½ million cases of ARF/yr globally

How much is around? Acute rheumatic fever

• Extremely rare overall BUT

• 1-2% of Aboriginal and Torres Strait Islander peoples

• 16 million people living with RHD globally

How much is around? Rheumatic heart disease

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FEMALES

MALES

How much is around? Rheumatic heart disease

How much is around? Why more in women?

0%

10%

20%

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0 - 10 10 - 20 20 - 30 30 - 40 40 - 50 50 - 60 60 -70 70 -80 80 - 90 ALL

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MALES

FEMALES

• More GAS infection

• Accelerated disease

• Greater diagnosis/access

Because ARF/RHD is preventable and the consequences can be

severe

So why do we worry about a relatively rare condition?

Population at risk

GAS colonization

GAS pharyngitis

ARF

RHD

Stopping it

Stopping it

Population at risk

GAS colonization

GAS pharyngitis

ARF

RHD

Stopping it

• RHD is rarely a reason for not getting pregnant BUT planning (and possibly treatment) before pregnancy is the key

• Preventing it – primary and secondary prevention

• Fertility planning/contraceptive advice in women with RHD is EVERYONE’S business

• What is it and what causes it

• How much is around (especially in women)

• Stopping it (especially as a problem in pregnancy)

• RHD in pregnancy

Rheumatic Heart Disease A National (international) Perspective

Why’s it important to you?

How much is around? Rheumatic heart disease

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0 - 10 10 - 20 20 - 30 30 - 40 40 - 50 50 - 60 60 -70 70 -80 80 - 90 ALL

% o

f A

RF/

RH

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Age group (yrs)

MALES

FEMALES