Acute rheumatic fever can recur, especially if left untreated
First known and recurrent acute rheumatic fever (ARF) episodes (Box 2.3) are preventable (Figure 1.2). After the first known ARF episode, adherence to secondary prophylaxis reduces the likelihood of recurrence.
Box 2.3: Acute rheumatic fever (ARF) recurrence status definitions
- First known episode
- A reported ARF episode (definite, probable, or possible) in an individual with no known past ARF or rheumatic heart disease (RHD).
- Recurrent episode
- A reported ARF episode (definite, probable, or possible) in an individual with known past ARF or RHD.
Of the 533 ARF diagnoses in 2022 among all Australians in New South Wales, Queensland, Western Australia, South Australia and the Northern Territory combined, 157 (30%) were recurrent cases.
Of the 505 ARF diagnoses among First Nations people in these jurisdictions, 152 (30%) were recurrent cases (Supplementary Table 2.8).
Further analysis on recurrence rates among First Nations people on prophylaxis can be found in Secondary prophylaxis.
Hospitalisations for ARF
To present a more complete picture of treatment journey for ARF patients, hospitalisation data is included in this box. The 2020 Australian guideline for the prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease recommends that people with suspected ARF be admitted to hospital to support timely and accurate diagnosis and prompt treatment (RHDAustralia 2020).
The data are drawn from the AIHW National Hospital Morbidity Database. This database includes data on all hospital admissions in Australia, in both public and private hospitals. Further information on how hospitalisation data are collected can be found in Appendix B.
In the 2021–22 financial year, there was a total of 554 hospital separations in NSW, Qld, WA, SA and NT where a diagnosis of ARF was recorded, of which 85% (471) were identified as people of Aboriginal and/or Torres Strait Islander origin.
Among these 471 hospital separations:
- there were more females (55%) than males (45%)
- almost half occurred among children aged under 15 years (Supplementary tables 2.9a and 2.9b – see Data).
Over time, the number and rate of ARF hospital separations among First Nations people increased, from 319 separations (49 per 100,000) in 2012–13 to 532 (69 per 100,000) in 2020–21, before dropping to 471 (60 per 100,000) in 2021–22. The number and rate for non-Indigenous Australians both decreased over this period (Supplementary tables 2.10).
Note: The data used for this analysis are de-identified, and so reflect the number of separate hospitalisation events occurring in each year, rather than the number of people admitted.
RHDAustralia (ARF/RHD writing group) (2020) The 2020 Australian guideline for the prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease, 3rd edn, RHDAustralia, Menzies School of Health Research, Darwin.