Haran Shankar, Crane Natalie, Kazi Saniya, Axford-Haines Louise, White Andrew
Townsville Hospital, Townsville, Queensland, Australia.
Townsville and Mackay Hospital and Health Service Rheumatic Heart Disease Registry, Townsville, Queensland, Australia.
Aust J Rural Health. 2018 Apr;26(2):119-125. doi: 10.1111/ajr.12379. Epub 2017 Nov 23.
To determine the effect of secondary penicillin prophylaxis on echocardiographic diagnosed valvular changes in patients with rheumatic heart disease or history of acute rheumatic fever in the Townsville Health district.
Patients with known were identified from the North Queensland register, serial echocardiogram results and number of secondary penicillin prophylaxis doses received in 2014 were collated. Descriptive statistics were utilised.
Townsville Hospital and outreach clinics within the Townsville Health catchment zone.
All patients diagnosed with acute rheumatic fever or rheumatic heart disease between 2010 and October 2013 who had serial echocardiograms prior to and post commencement of secondary penicillin prophylaxis were included. All patients were of Aboriginal or Torres Strait Islander descent.
Progression of echocardiographic valvular changes and association with secondary penicillin prophylaxis compliance. Compliance with secondary penicillin prophylaxis among the study population was a secondary outcome measure.
Twenty-three patients were recruited. Only those patients who were compliant with secondary penicillin prophylaxis had any improvement in valvular changes on echocardiogram. Four of six patients without any baseline valvular involvement developed new valvular changes. Seventy percent of patients received >75% of secondary penicillin prophylaxis doses.
This small study of patients in Townsville suggests that with good secondary penicillin prophylaxis compliance there is regression of some cardiac lesions over time in people with rheumatic heart disease. Furthermore the natural history of acute rheumatic fever in the Indigenous population is progressive requiring strict adherence to secondary penicillin prophylaxis. Prospective studies or use of data from the nationwide RHD register and standardised reporting of cardiac echocardiograms will provide more robust evidence.
确定二级青霉素预防性治疗对汤斯维尔健康区风湿性心脏病患者或有急性风湿热病史患者经超声心动图诊断的瓣膜病变的影响。
从北昆士兰登记册中识别出已知患者，整理2014年连续超声心动图结果及接受二级青霉素预防性治疗的剂量数。采用描述性统计方法。
汤斯维尔医院及汤斯维尔健康服务范围内的外展诊所。
纳入2010年至2013年10月期间诊断为急性风湿热或风湿性心脏病且在开始二级青霉素预防性治疗前后均进行过连续超声心动图检查的所有患者。所有患者均为原住民或托雷斯海峡岛民后裔。
超声心动图瓣膜病变的进展情况以及与二级青霉素预防性治疗依从性的关联。研究人群中二级青霉素预防性治疗的依从性为次要观察指标。
招募了23名患者。只有那些依从二级青霉素预防性治疗的患者超声心动图显示瓣膜病变有改善。6名基线时无瓣膜受累的患者中有4名出现了新的瓣膜病变。70%的患者接受了超过75%的二级青霉素预防性治疗剂量。
这项对汤斯维尔患者的小型研究表明，对于风湿性心脏病患者，若能良好依从二级青霉素预防性治疗，随着时间推移一些心脏病变会有所消退。此外，原住民急性风湿热的自然病程呈进行性发展，需要严格坚持二级青霉素预防性治疗。前瞻性研究或使用全国风湿性心脏病登记册的数据以及心脏超声心动图的标准化报告将提供更有力的证据。
