Abstract：
OBJECTIVE: To describe the clinical profile of acute rheumatic fever (ARF) presentations to paediatric cardiology tertiary services in Western Australia (WA).
METHODS: A retrospective clinical audit of individuals with confirmed ARF referred to the only paediatric tertiary cardiac service in WA (1 January 1987 to 31 December 2020). Comparisons between inpatient, outpatient, remote and non-remote groups were assessed.
RESULTS: Four hundred seventy-one episodes of ARF in 457 individuals (235 male; median age = 8 years) met clinical criteria. The majority were Aboriginal and Torres Strait Islander children (91.2%), with 62.1% living in remote areas. The number of ARF and rheumatic heart disease (RHD) diagnoses per year increased from 1987 to 2017 with notable peaks in 2013 and 2017. The average annual incidence of tertiary-referred ARF in WA of 4-15-year-olds from 1987 to 2020 was 4.96 per 100 000. ARF features included carditis (59.9%), chorea (31%), polyarthritis (30%) and polyarthralgia (24.2%). RHD was evident in 61.8% of cases and predominantly manifested as mitral regurgitation (55.7%). Thirty-four children (7.4%) with severe RHD underwent valvular surgery. 12% had at least one recurrent ARF episode. Remote individuals had more than double the rate of recurrence compared to non-remote individuals (P = 0.0058). Compared to non-remote episodes, remote presentations had less polyarthritis (P = 0.0022) but greater proportions of raised ESR (P = 0.01), ASOT titres (P = 0.0073), erythema marginatum (P = 0.0218) and severe RHD (P = 0.0133).
CONCLUSIONS: The high proportion of Aboriginal and Torres Strait Islander Australians affected by ARF/RHD in WA reflects the significant burden of disease within this population. Children from remote communities were more likely to present with concurrent severe RHD. Our study reinforces the persisting need to improve primary and secondary ARF initiatives in rural and remote communities.
METHODS: A retrospective clinical audit of individuals with confirmed ARF referred to the only paediatric tertiary cardiac service in WA (1 January 1987 to 31 December 2020). Comparisons between inpatient, outpatient, remote and non-remote groups were assessed.
RESULTS: Four hundred seventy-one episodes of ARF in 457 individuals (235 male; median age = 8 years) met clinical criteria. The majority were Aboriginal and Torres Strait Islander children (91.2%), with 62.1% living in remote areas. The number of ARF and rheumatic heart disease (RHD) diagnoses per year increased from 1987 to 2017 with notable peaks in 2013 and 2017. The average annual incidence of tertiary-referred ARF in WA of 4-15-year-olds from 1987 to 2020 was 4.96 per 100 000. ARF features included carditis (59.9%), chorea (31%), polyarthritis (30%) and polyarthralgia (24.2%). RHD was evident in 61.8% of cases and predominantly manifested as mitral regurgitation (55.7%). Thirty-four children (7.4%) with severe RHD underwent valvular surgery. 12% had at least one recurrent ARF episode. Remote individuals had more than double the rate of recurrence compared to non-remote individuals (P = 0.0058). Compared to non-remote episodes, remote presentations had less polyarthritis (P = 0.0022) but greater proportions of raised ESR (P = 0.01), ASOT titres (P = 0.0073), erythema marginatum (P = 0.0218) and severe RHD (P = 0.0133).
CONCLUSIONS: The high proportion of Aboriginal and Torres Strait Islander Australians affected by ARF/RHD in WA reflects the significant burden of disease within this population. Children from remote communities were more likely to present with concurrent severe RHD. Our study reinforces the persisting need to improve primary and secondary ARF initiatives in rural and remote communities.
摘要：
目的：描述西澳大利亚（WA）儿科心脏病学三级服务的急性风湿热（ARF）临床表现。
方法：对确诊ARF的个体进行回顾性临床审核，参考西澳唯一的儿科三级心脏服务（1987年1月1日至2020年12月31日）。住院患者之间的比较，门诊病人,对远程和非远程组进行了评估.
结果：457名个体（235名男性；中位年龄=8岁）中发生了471次ARF符合临床标准。大多数是土著和托雷斯海峡岛民儿童(91.2%)，62.1%生活在偏远地区。从1987年到2017年，每年ARF和风湿性心脏病（RHD）的诊断数量增加，2013年和2017年达到显着高峰。从1987年到2020年，4-15岁的西澳大利亚州第三级转诊ARF的年平均发病率为4.96/100000。ARF特征包括心脏炎（59.9％），舞蹈病（31%），多关节炎（30％）和多关节痛（24.2％）。RHD在61.8％的病例中明显，主要表现为二尖瓣反流（55.7％）。患有严重RHD的34名儿童（7.4％）接受了瓣膜手术。12%的患者有至少一次复发性ARF发作。远程个体的复发率是非远程个体的两倍以上(P=0.0058)。与非远程事件相比，远程就诊的多关节炎较少（P=0.0022），但ESR升高的比例较大（P=0.01），ASOT滴度（P=0.0073），边缘红斑(P=0.0218)和重度RHD(P=0.0133)。
结论：西澳大利亚州受ARF/RHD影响的澳大利亚原住民和托雷斯海峡岛民的比例很高，反映了该人群的重大疾病负担。来自偏远社区的儿童更有可能并发严重的RHD。我们的研究加强了在农村和偏远社区改善初级和次级ARF计划的持续需求。
方法：对确诊ARF的个体进行回顾性临床审核，参考西澳唯一的儿科三级心脏服务（1987年1月1日至2020年12月31日）。住院患者之间的比较，门诊病人,对远程和非远程组进行了评估.
结果：457名个体（235名男性；中位年龄=8岁）中发生了471次ARF符合临床标准。大多数是土著和托雷斯海峡岛民儿童(91.2%)，62.1%生活在偏远地区。从1987年到2017年，每年ARF和风湿性心脏病（RHD）的诊断数量增加，2013年和2017年达到显着高峰。从1987年到2020年，4-15岁的西澳大利亚州第三级转诊ARF的年平均发病率为4.96/100000。ARF特征包括心脏炎（59.9％），舞蹈病（31%），多关节炎（30％）和多关节痛（24.2％）。RHD在61.8％的病例中明显，主要表现为二尖瓣反流（55.7％）。患有严重RHD的34名儿童（7.4％）接受了瓣膜手术。12%的患者有至少一次复发性ARF发作。远程个体的复发率是非远程个体的两倍以上(P=0.0058)。与非远程事件相比，远程就诊的多关节炎较少（P=0.0022），但ESR升高的比例较大（P=0.01），ASOT滴度（P=0.0073），边缘红斑(P=0.0218)和重度RHD(P=0.0133)。
结论：西澳大利亚州受ARF/RHD影响的澳大利亚原住民和托雷斯海峡岛民的比例很高，反映了该人群的重大疾病负担。来自偏远社区的儿童更有可能并发严重的RHD。我们的研究加强了在农村和偏远社区改善初级和次级ARF计划的持续需求。
