Heart, stroke and vascular disease: Australian facts

What are acute rheumatic fever and rheumatic heart disease?

Acute rheumatic fever

Acute rheumatic fever (ARF) is an autoimmune response to an infection of the upper respiratory tract by group A streptococcus bacteria. The infection can cause inflammation throughout the body including the heart, brain, skin and joints.

Early detection and treatment can prevent the bacterial infection progressing to ARF. The risk of ARF recurrence is high following an initial episode, and repeated episodes increase the chance of long-term heart valve damage.

ARF is rare among most Australians but still has a substantial impact on First Nations communities. For more information, see First Nations people.

Rheumatic heart disease

Rheumatic heart disease (RHD) is permanent damage of the heart muscle or heart valves as a result of ARF. RHD reduces the ability of the heart to pump blood effectively around the body, leading to symptoms such as shortness of breath after physical activity, fatigue and weakness. Severe forms can result in serious incapacity or death.

Symptoms of RHD can also occur with other heart conditions, making a diagnosis more difficult. Signs of damage detected by echocardiography and a history of ARF are both important clinical indicators for RHD diagnosis.

How many Australians are living with acute rheumatic fever and rheumatic heart disease?

As at 31 December 2024, there were 7,500 (71 per 100,000 population) people living with RHD recorded on registers in Queensland, Western Australia, South Australia and the Northern Territory (AIHW 2025).

Of these:

• 28% were aged under 25 (2,100 diagnoses)
• around 66% were female (4,900 diagnoses)
• Northern Territory had the highest prevalence (1,100 per 100,000 population) and Queensland had the greatest number of people on their register (3,200 people).

Hospitalisations

Because hospital records may not always distinguish between ARF and RHD, the 2 diseases are grouped together in this section.

In 2023–24, there were 6,300 hospitalisations with a principal diagnosis of ARF or RHD – 1.0% of all cardiovascular disease (CVD) hospitalisations, equating to a rate of 23 hospitalisations per 100,000 population.

Age and sex

In 2023–24, where ARF or RHD was recorded as the principal diagnosis, hospitalisation rates:

• were similar for males and females after adjusting for differences in the age structure of the populations
• were slightly higher among females than males among those aged 15–54, and higher among males from age 55 and over (Figure 1)
• were highest among females aged 75–84 – around 2.5 times as high as those aged 65–74. Among males, the rate was highest among those aged 85 and over.

Trends

Between 2000–01 and 2023–24 the number of hospitalisations with ARF or RHD increased from 2,100 to 6,300. Over this period the age-standardised hospitalisation rates for ARF and RHD increased by 80% (Figure 2).

Variation by priority population groups

In 2023–24, ARF and RHD hospitalisation rates were:

• 1.5 times as high for people living in the lowest socioeconomic areas compared with those in the highest socioeconomic areas. The difference was greater for females (1.7 times as high) than males (1.3 times as high)
• 6.5 times as high among people living in Remote and very remote areas compared with those in Major cities. The difference was greater for females (8.4 times as high) than males (4.7 times as high). This reflects substantially higher rates among the First Nations population.

For information about First Nations people, see First Nations people. For data disaggregated by priority populations, see the supplementary data tables.

Deaths

Deaths from ARF and RHD are uncommon in Australia, and, as with hospitalisations, death records may not distinguish well between ARF and RHD. Here, the 2 conditions are presented together.

In 2024, ARF or RHD was the underlying cause of 376 deaths, representing 0.2% of all deaths and 0.9% of CVD deaths, and equivalent to 1.4 deaths per 100,000 population.

Age and sex

Unlike many other forms of CVD, more females die from ARF and RHD than males. In 2024, females accounted for 62% of ARF and RHD deaths – 234 deaths compared with 142 for males.

In 2024, ARF and RHD death rates:

• were 1.3 times as high for females as for males, after adjusting for age differences in the populations
• increased with age, with 70% of all ARF and RHD deaths occurring in those aged 75 and over. ARF and RHD death rates for males and females were highest in the 85 and over age group – 5.1 times as high for males and 3.5 times as high for females aged 75–84 (Figure 3).

Trends

Between 1980 and 2024:

• the number of ARF and RHD deaths increased by 23%, from 306 to 376
• the age-standardised ARF and RHD death rate declined by 63%. Much of the decline occurred before 2000. See supplementary data tables for rates.

Variation by priority population groups

In 2024, the age-standardised ARF and RHD death rate was:

• 2.1 times as high for people living in the lowest socioeconomic areas compared with people living in the highest socioeconomic areas. The rate for males was 1.4 times as high, and 2.4 times as high for females
• increased with remoteness. Rates were 5 times as high in Remote and very remote areas compared with Major cities. This is, in part, driven by higher burden among the First Nations population. For information on First Nations people, see First Nations people.

Data disaggregated by priority population groups are available in the supplementary data tables.

Reference

AIHW (Australian Institute of Health and Welfare) (2025) Acute rheumatic fever and rheumatic heart disease in Australia, AIHW, Australian Government, accessed 23 February 2026.