RHD Action

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Improving Secondary Prophylaxis for Rheumatic Heart Disease in Remote Indigenous Communities: A Stepped Wedge Community Randomised Trial

Clancy Read*¹, Jonathan Carapetis¹, Anna Ralph², Vanessa Johnston², Jessica de Dassel², Kerstin Bycroft², Alice Mitchell³, Ross Bailie⁴, Graeme Maguire⁵, Keith Edwards⁶, Bart Currie², Adrienne Kirby⁷

¹Telethon Kids Institute, University of Western Australia, Perth, ²Menzies School of Health Research, Darwin, ³Charles Darwin University, Darwin, ⁴Menzies School of Health Research, Brisbane, ⁵BakerIDI Heart and Diabetes Institute, Melbourne, ⁶Paediatric Department, Royal Darwin Hospital, Darwin, ⁷National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney

Introduction:
Rheumatic heart disease (RHD), caused by acute rheumatic fever (ARF), is a major health problem in Australian Aboriginal communities. Progress in controlling RHD requires improvements in the delivery of secondary prophylaxis, which comprises regular, long-term injections of penicillin for people with ARF/RHD.

Objectives:
This study aims to improve uptake of secondary prophylaxis among Aboriginal people with ARF/RHD, to reduce progression or worsening of RHD.

Methods:
This is a stepped-wedge, randomised trial in consenting communities in Australia’s Northern Territory. Pairs of randomly-chosen clinics from among those consenting enter the study at three-monthly steps. The intervention to which clinics are randomised comprises a multifaceted systems-based package, in which clinics are supported to develop and implement strategies to improve penicillin delivery, aligned with elements of the Chronic Care Model. Continuous quality improvement processes will be used, including three-monthly feedback to clinic staff of adherence rates of their ARF/RHD clients. The primary outcome is the proportion of people with ARF/RHD receiving ≥80% of scheduled penicillin injections over a minimum 12-month period. The sample size of 300 ARF/RHD clients across five community clusters will power the study to detect a 20% increase in proportion of individuals achieving this target, from a worrying low baseline of 20% to 40%.

Secondary outcomes pertaining to other measures of adherence will be assessed. Within the randomised trial design, a mixed-methods evaluation will be embedded to evaluate the efficiency, effectiveness, impact and relevance, sustainability, process and fidelity, and performance of the intervention. The evaluation will establish any causal link between outcomes and the intervention. The planned study duration is 2013 – 2016.

Results:
The planned study duration is 2013-2016. Results are expected by the end of 2016

Conclusion:
Continuous quality improvement has a strong track record in Australia’s Northern Territory, and its use resulted in modest benefits in a pilot, non-randomised ARF/RHD study. If successful, this new intervention using the Chronic Care Model as a scaffold, evaluated using a well-developed theory-based framework, will provide a practical and transferable approach to ARF/RHD control.

Disclosure of Interest:
None Declared

*This poster was presented at the World Congress of Cardiology and Cardiovascular Health, Mexico City, 2016

• International
• English
• Specialist clinician - cardiology

An unusual case presented by the ESC Working Group on Valvular Heart Disease

Bernard Iung, MD
Bichat Hospital, Paris, France

• International
• English
• Media

One of the largest clinical studies in Rheumatic Heart Disease 'Invictus' was launched at 2016 World Congress of Cardiology & Cardiovascular Health (WCC 2016). Bongani Mayosi, Professor of Medicine, University of Cape Town, discusses 'Invictus' and the ongoing challenges in treating the disease.

• International
• English
• Communities

WCC TV interviews Professor of Medicine at University of Cape Town, Bongani Mayosi to talk to us about the Rheumatic Heart Disease launch of research that is currently happening.

• International
• Communities

My name is Emmanuel Rusingiza. I'm a pediatric cardiologist at Kigali University Teaching Hospital, Rwanda. I'm going to talk about the diagnosis and management of rheumatic heart disease.

OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user.

For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

• International
• English
• Clinician - community health worker

WCC TV talks with Dr Liesl Zuhlke of the 2016 Program Committee for the World Congress of Cardiology and Cardiovascular Health to hear about the process of getting the meeting together and why she wanted to get involved.

• International
• English
• Clinician - community health worker

The RhEACH team of the RHD Action Alliance presents a Needs Assessment Tool (NAT) of processes and data collection instruments recommended for conducting a comprehensive needs assessment in local communities in ARF/RHD endemic countries. This NAT aims to provide guidance and structure to the development of targeted interventions to prevent and control ARF and RHD. It makes use of scientifically validated methods and is designed as a collection of tools for public health practice. It provides technical guidance based on the experience of ARF/RHD programmes in resource-limited settings and focuses on the key data required for developing and monitoring interventions. 

• International
• English
• Clinician - community health worker

World Congress of Cardiology and Cardiovascular Health 2016: Congress Program Committee.

Interview with Dr Liesl Zühlke, MBChB, DCH, FCPaeds, MPH, FESC, PhD (WCC Topic Leader: Other cardiac diseases including Rheumatic Heart Fever and Chagas disease)

For more information:
Rheumatic fever / rheumatic heart disease content at the World Congress of Cardiology and Cardiovascular Health 2016

• Australia
• English
• Clinician - community health worker

An outline of how well we recognize and manage ARF and RHD, presented by Steve Brady.

On the 16th August 2008 Indigenous health workers, nurses and doctors from Australia and New Zealand gathered in Alice Springs to share stories and knowledge about acute rheumatic fever and rheumatic heart disease. The complied presentations provide a unique and valuable insight into preventing and managing ARF/RHD for all clinicians - from those with little experience of these conditions through to experienced health care providers.

• Australia
• English
• Clinician - community health worker

ARF RHD CQI in specialist and primary health care | Graeme Maguire, Malcolm McDonald.

On the 16th August 2008 Indigenous health workers, nurses and doctors from Australia and New Zealand gathered in Alice Springs to share stories and knowledge about acute rheumatic fever and rheumatic heart disease. The complied presentations provide a unique and valuable insight into preventing and managing ARF/RHD for all clinicians - from those with little experience of these conditions through to experienced health care providers.

• Australia
• English
• Clinician - community health worker

Experienced healthcare providers (Catherine Atkinson, Paula Harrison, Malcolm McDonald, Martha Ngawaka) from Australia and New Zealand share their experience and perspectives on implementing successful secondary prevention programs for ARF/RHD.

On the 16th August 2008 Indigenous health workers, nurses and doctors from Australia and New Zealand gathered in Alice Springs to share stories and knowledge about acute rheumatic fever and rheumatic heart disease. The complied presentations provide a unique and valuable insight into preventing and managing ARF/RHD for all clinicians - from those with little experience of these conditions through to experienced health care providers.

On the 16th August 2008 Indigenous health workers, nurses and doctors from Australia and New Zealand gathered in Alice Springs to share stories and knowledge about acute rheumatic fever and rheumatic heart disease. The complied presentations provide a unique and valuable insight into preventing and managing ARF/RHD for all clinicians - from those with little experience of these conditions through to experienced health care providers.

• Australia
• English
• People living with RF/RHD

ARF RHD Patient Education, Catherine Atkinson, Malcolm McDonald, Martha Ngawaka, Sara Noonan (August 2008).

On the 16th August 2008 Indigenous health workers, nurses and doctors from Australia and New Zealand gathered in Alice Springs to share stories and knowledge about acute rheumatic fever and rheumatic heart disease. The complied presentations provide a unique and valuable insight into preventing and managing ARF/RHD for all clinicians - from those with little experience of these conditions through to experienced health care providers.

• International
• English
• Communities

An introduction to acute rheumatic fever and rheumatic heart disease and their impact at a global and local level. Presented by Jonathan Carapetis (August 2008).

• Australia
• English
• Clinician - community health worker

A case based discussion of issues relating to the management of RHD in pregnant women presented by Jaye Martin.

• International
• English
• Communities

Nigel Wilson, a paediatric cardiologist with experience in research and clinical care in New Zealand and the Pacific shares a regional perspective on ARF and RHD in Oceania.