Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
Heart Lung Circ. 2010 May-Jun;19(5-6):273-81. doi: 10.1016/j.hlc.2010.02.019. Epub 2010 Mar 30.
Rates of acute rheumatic fever and chronic rheumatic heart disease in Aboriginal people, Torres Strait Islanders and Māori continue to be unacceptably high. The impact of rheumatic heart disease is inequitable on these populations as compared with other Australians and New Zealanders. The associated cardiac morbidity, including the development of rheumatic valve disease, and cardiomyopathy, with possible sequelae of heart failure, development of atrial fibrillation, systemic embolism, transient ischaemic attacks, strokes, endocarditis, the need for interventions including cardiac surgery, and impaired quality of life, and shortened life expectancy, has major implications for the individual. The adverse health and social effects may significantly limit education and employment opportunities and increase dependency on welfare. Additionally there may be major adverse impacts on family and community life. The costs in financial terms and missed opportunities, including wasted young lives, are substantial. Prevention of acute rheumatic fever is dependent on the timely diagnosis and treatment of sore throats and skin infections in high-risk groups. Both Australia and New Zealand have registries for acute rheumatic fever but paradoxically neither includes all cases of chronic rheumatic heart disease many of whom would benefit from close surveillance and follow-up. In New Zealand and some Australian States there are programs to give secondary prophylaxis with penicillin, but these are not universal. Surgical outcomes for patients with rheumatic valvular disease are better for valve repair than for valve replacement. Special attention to the selection of the appropriate valve surgery and valve choice is required in pregnant women. It may be necessary to have designated surgical units managing Indigenous patients to ensure high rates of surgical repair rather than valve replacement. Surgical guidelines may be helpful. Long-term follow-up of the outcomes of surgery in Indigenous patients with rheumatic heart disease is required. Underpinning these strategies is the need to improve poverty, housing, education and employment. Cultural empathy with mutual trust and respect is essential. Involvement of Indigenous people in decision making, design, and implementation of primary and secondary prevention programs, is mandatory to reduce the unacceptably high rates of rheumatic heart disease.
原住民、托雷斯海峡岛民和毛利人患急性风湿热和慢性风湿性心脏病的比率仍然高得令人无法接受。与其他澳大利亚人和新西兰人相比，风湿性心脏病对这些人群的影响是不平等的。相关的心脏发病率，包括风湿性瓣膜病和心肌病的发展，以及可能导致心力衰竭、心房颤动、全身栓塞、短暂性脑缺血发作、中风、心内膜炎、需要心脏手术等干预措施以及生活质量受损和预期寿命缩短，对个人有重大影响。不良的健康和社会影响可能会严重限制教育和就业机会，并增加对福利的依赖。此外，还可能对家庭和社区生活产生重大影响。在经济方面的成本和错失的机会，包括浪费年轻的生命，是巨大的。预防急性风湿热取决于及时诊断和治疗高危人群的喉咙痛和皮肤感染。澳大利亚和新西兰都有急性风湿热登记处，但矛盾的是，两者都没有包括所有慢性风湿性心脏病病例，其中许多人将受益于密切监测和随访。在新西兰和一些澳大利亚州，有计划用青霉素进行二级预防，但并非普遍适用。风湿性瓣膜病患者的手术结果，瓣膜修复优于瓣膜置换。在孕妇中，需要特别注意选择适当的瓣膜手术和瓣膜选择。可能需要有指定的外科单位来管理土著患者，以确保高比例的外科修复而不是瓣膜置换。手术指南可能会有所帮助。需要对患有风湿性心脏病的土著患者的手术结果进行长期随访。这些策略的基础是需要改善贫困、住房、教育和就业。文化共鸣、相互信任和尊重是必不可少的。必须让原住民参与决策、设计和实施初级和二级预防计划，以降低风湿性心脏病的高发病率。
