Surgery for rheumatic heart disease in the Northern Territory, Australia, 1997–2016: what have we gained?
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Published:2023-03
Issue:3
Volume:8
Page:e011763
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ISSN:2059-7908
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Container-title:BMJ Global Health
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language:en
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Short-container-title:BMJ Glob Health
Author:
Doran JamesORCID, 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 RosemaryORCID, Doran Jonathan, Webster Andrew, Hanson Joshua
Abstract
BackgroundBetween 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.MethodsA 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.FindingsThe 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.InterpretationSurvival 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.
Subject
Public Health, Environmental and Occupational Health,Health Policy
Reference37 articles.
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