Surgery for rheumatic heart disease in the Northern Territory, Australia, 1997-2016: what have we gained?
Doran, James, Canty, David, Dempsey, Karen, Cass, Alan, Kangaharan, Nadarajah, Remenyi, Bo, Brunsdon, Georgie, McDonald, Malcolm, Heal, Clare, Wang, Zhiqiang, Royse, Colin, Royse, Alistair, Mein, Jacqueline, Gray, Nigel, Bennetts, Jayme, Baker, Robert A., Stewart, Maida, Sutcliffe, Steven, Reeves, Benjamin, Doran, Upasna, Rankine, Patricia, Fejo, Richard, Heenan, Elisabeth, Jalota, Ripudaman, Ilton, Marcus, Roberts-Thomson, Ross, King, Jason, Wyber, Rosemary, Doran, Jonathan, Webster, Andrew, and Hanson, Joshua (2023) Surgery for rheumatic heart disease in the Northern Territory, Australia, 1997-2016: what have we gained? BMJ Global Health, 8. e011763.
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Abstract
Background: Between 1964 and 1996, the 10-year survival of patients having valve replacement surgery for rheumatic heart disease (RHD) in the Northern Territory, Australia, was 68%. As medical care has evolved since then, this study aimed to determine whether there has been a corresponding improvement in survival.
Methods: A retrospective study of Aboriginal patients with RHD in the Northern Territory, Australia, having their first valve surgery between 1997 and 2016. Survival was examined using Kaplan-Meier and Cox regression analysis.
Findings: The cohort included 281 adults and 61 children. The median (IQR) age at first surgery was 31 (18-42) years; 173/342 (51%) had a valve replacement, 113/342 (33%) had a valve repair and 56/342 (16%) had a commissurotomy. There were 93/342 (27%) deaths during a median (IQR) follow-up of 8 (4-12) years. The overall 10-year survival was 70% (95% CI: 64% to 76%). It was 62% (95% CI: 53% to 70%) in those having valve replacement. There were 204/281 (73%) adults with at least 1 preoperative comorbidity. Preoperative comorbidity was associated with earlier death, the risk of death increasing with each comorbidity (HR: 1.3 (95% CI: 1.2 to 1.5), p<0.001). Preoperative chronic kidney disease (HR 6.5 (95% CI: 3.0 to 14.0) p≤0.001)), coronary artery disease (HR 3.3 (95% CI: 1.3 to 8.4) p=0.012) and pulmonary artery systolic pressure>50 mm Hg before surgery (HR 1.9 (95% CI: 1.2 to 3.1) p=0.007) were independently associated with death.
Interpretation: Survival after valve replacement for RHD in this region of Australia has not improved. Although the patients were young, many had multiple comorbidities, which influenced long-term outcomes. The increasing prevalence of complex comorbidity in the region is a barrier to achieving optimal health outcomes.
| Item ID: | 78350 |
|---|---|
| Item Type: | Article (Research - C1) |
| ISSN: | 2059-7908 |
| Keywords: | Child health, Public Health, Thoracic surgery, Treatment |
| Copyright Information: | © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. |
| Date Deposited: | 11 Oct 2023 00:04 |
| FoR Codes: | 32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320101 Cardiology (incl. cardiovascular diseases) @ 50% 45 INDIGENOUS STUDIES > 4504 Aboriginal and Torres Strait Islander health and wellbeing > 450402 Aboriginal and Torres Strait Islander biomedical and clinical sciences @ 50% |
| SEO Codes: | 21 INDIGENOUS > 2103 Aboriginal and Torres Strait Islander health > 210399 Aboriginal and Torres Strait Islander health not elsewhere classified @ 100% |
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