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. 2020 Nov:213 Suppl 10:S3-S31.
doi: 10.5694/mja2.50853.

Ending rheumatic heart disease in Australia: the evidence for a new approach

Rosemary Wyber  1   2 , Katharine Noonan  2 , Catherine Halkon  2 , Stephanie Enkel  2 , Jeffrey Cannon  2 , Emma Haynes  3 , Alice G Mitchell  4 , Dawn C Bessarab  3 , Judith M Katzenellenbogen  2   3 , Daniela Bond-Smith  3 , Rebecca Seth  2   3 , Heather D'Antoine  4 , Anna P Ralph  4 , Asha C Bowen  2   5 , Alex Brown  6   7 , Jonathan R Carapetis  2   5 ; END RHD CRE Investigators Collaborators
Affiliations

Ending rheumatic heart disease in Australia: the evidence for a new approach

Rosemary Wyber et al. Med J Aust. 2020 Nov.

Abstract

■The RHD Endgame Strategy: the blueprint to eliminate rheumatic heart disease in Australia by 2031 (the Endgame Strategy) is the blueprint to eliminate rheumatic heart disease (RHD) in Australia by 2031. Aboriginal and Torres Strait Islander people live with one of the highest per capita burdens of RHD in the world. ■The Endgame Strategy synthesises information compiled across the 5-year lifespan of the End Rheumatic Heart Disease Centre of Research Excellence (END RHD CRE). Data and results from priority research projects across several disciplines of research complemented literature reviews, systematic reviews and narrative reviews. Further, the experiences of those working in acute rheumatic fever (ARF) and RHD control and those living with RHD to provide the technical evidence for eliminating RHD in Australia were included. ■The lived experience of RHD is a critical factor in health outcomes. All future strategies to address ARF and RHD must prioritise Aboriginal and Torres Strait Islander people's knowledge, perspectives and experiences and develop co-designed approaches to RHD elimination. The environmental, economic, social and political context of RHD in Australia is inexorably linked to ending the disease. ■Statistical modelling undertaken in 2019 looked at the economic and health impacts of implementing an indicative strategy to eliminate RHD by 2031. Beginning in 2019, the strategy would include: reducing household crowding, improving hygiene infrastructure, strengthening primary health care and improving secondary prophylaxis. It was estimated that the strategy would prevent 663 deaths and save the health care system $188 million. ■The Endgame Strategy provides the evidence for a new approach to RHD elimination. It proposes an implementation framework of five priority action areas. These focus on strategies to prevent new cases of ARF and RHD early in the causal pathway from Streptococcus pyogenes exposure to ARF, and strategies that address the critical systems and structural changes needed to support a comprehensive RHD elimination strategy.

Keywords: Indigenous health; Rheumatic heart disease; Streptococcus.

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References

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    1. Wyber R, Cannon J, Katzenellenbogen JM. The cost of inaction on rheumatic heart disease: the predicted human and financial costs of rheumatic heart disease for Aboriginal and Torres Strait Islander people 2016-2031. Perth, END RHD Centre of Research Excellence, Telethon Kids Institute, 2018.
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