Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
Aboriginal Community Controlled Health Organisation, Gurriny Yealamucka Health Service Aboriginal Corporation, Yarrabah, Queensland, Australia.
BMJ Glob Health. 2023 Mar;8(3). doi: 10.1136/bmjgh-2023-011763.
Between 1964 and 1996, the 10-year survival of patients having valve replacement surgery for rheumatic heart disease (RHD) in the Northern Territory, Australia, was 68%. As medical care has evolved since then, this study aimed to determine whether there has been a corresponding improvement in survival.
A retrospective study of Aboriginal patients with RHD in the Northern Territory, Australia, having their first valve surgery between 1997 and 2016. Survival was examined using Kaplan-Meier and Cox regression analysis.
The cohort included 281 adults and 61 children. The median (IQR) age at first surgery was 31 (18-42) years; 173/342 (51%) had a valve replacement, 113/342 (33%) had a valve repair and 56/342 (16%) had a commissurotomy. There were 93/342 (27%) deaths during a median (IQR) follow-up of 8 (4-12) years. The overall 10-year survival was 70% (95% CI: 64% to 76%). It was 62% (95% CI: 53% to 70%) in those having valve replacement. There were 204/281 (73%) adults with at least 1 preoperative comorbidity. Preoperative comorbidity was associated with earlier death, the risk of death increasing with each comorbidity (HR: 1.3 (95% CI: 1.2 to 1.5), p<0.001). Preoperative chronic kidney disease (HR 6.5 (95% CI: 3.0 to 14.0) p≤0.001)), coronary artery disease (HR 3.3 (95% CI: 1.3 to 8.4) p=0.012) and pulmonary artery systolic pressure>50 mm Hg before surgery (HR 1.9 (95% CI: 1.2 to 3.1) p=0.007) were independently associated with death.
Survival after valve replacement for RHD in this region of Australia has not improved. Although the patients were young, many had multiple comorbidities, which influenced long-term outcomes. The increasing prevalence of complex comorbidity in the region is a barrier to achieving optimal health outcomes.
1964 年至 1996 年间，澳大利亚北部地区因风湿性心脏病（RHD）接受瓣膜置换手术的患者 10 年生存率为 68%。自那时以来，随着医疗保健的发展，本研究旨在确定生存率是否有相应提高。
对澳大利亚北部地区因 RHD 接受首次瓣膜手术的 1997 年至 2016 年期间的原住民患者进行回顾性研究。使用 Kaplan-Meier 和 Cox 回归分析检查生存率。
该队列包括 281 名成年人和 61 名儿童。首次手术时的中位（IQR）年龄为 31（18-42）岁；173/342（51%）行瓣膜置换术，113/342（33%）行瓣膜修复术，56/342（16%）行交界切开术。342 例中有 93 例（27%）在中位（IQR）8（4-12）年的随访期间死亡。总体 10 年生存率为 70%（95%CI：64%至 76%）。瓣膜置换组为 62%（95%CI：53%至 70%）。281 例中有 204 例（73%）成年人术前至少有一种合并症。术前合并症与早期死亡相关，每增加一种合并症死亡风险增加（HR：1.3（95%CI：1.2 至 1.5），p<0.001）。术前慢性肾脏病（HR 6.5（95%CI：3.0 至 14.0）p≤0.001））、冠状动脉疾病（HR 3.3（95%CI：1.3 至 8.4）p=0.012）和术前肺动脉收缩压>50mmHg（HR 1.9（95%CI：1.2 至 3.1）p=0.007）与死亡独立相关。
在澳大利亚该地区，因 RHD 接受瓣膜置换术的患者生存率没有提高。尽管患者年龄较小，但许多人患有多种合并症，这影响了长期结果。该地区复杂合并症的患病率不断增加是实现最佳健康结果的障碍。
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