ID-5184 Wonca Abstracts supplement A-K 13-10-23 - Flipbook - Page 181
WONCA 2023 Supplement 1: WONCA 2023 abstracts (A–K)
A
B
C
Rheumatic heart disease in the Northern Territory, Australia
1997–2016: What have we gained?
Dr James Doran1, Josh Hansen2
D
E
F
G
H
I
J
K
1
Menzies School of Health Research, 2The Kirby Institute, University of New South Wales,
Sydney, Australia
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 the region’s RHD patients’ 10-year survival.
Methods
A retrospective study of Aboriginal RHD patients in the Northern Territory, Australia, having their
first valve surgery between 1997 and 2016. Survival was examined using Kaplan–Meier and Cox
regression analyses.
Findings
The cohort included 281 adults and 61 children. The median (interquartile range [IQR]) age at first
surgery was 31 (18–42) years; 173/342 (51%) had a valve replacement. Of 281 adults, 204 (73%)
had at least one preoperative comorbidity. 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% confidence interval [CI]: 64, 76),
while it was 62% (95% CI: 53, 70) in those having a valve replacement. Preoperative comorbidity was
associated with earlier death, the risk of death increasing with each comorbidity (hazard ratio [HR] 1.3;
95% CI: 1.2, 1.5; P < 0.001). Preoperative chronic kidney disease (HR 6.1; 95% CI: 2.8, 13.3; P
50 mmHg before surgery (HR 2.1; 95% CI: 1.3, 3.5; P = 0.002) independently predicted death.
Interpretation
Survival after RHD surgery 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.
179