{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T05:48:46Z","timestamp":1785476926001,"version":"3.56.0"},"reference-count":31,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T00:00:00Z","timestamp":1741564800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Australian J Rural Health"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Preventable rheumatic heart disease (RHD) deaths continue to occur in Australia, with Aboriginal people disproportionately affected. Despite research into structural drivers and the lived experience of people with RHD, and national guidelines focusing on RHD prevention and treatment, recent coronial inquests have highlighted that systemic failures are ongoing. Few studies describe RHD service delivery and\/or mortality within the Western Australian (WA) context.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aimed to integrate quantitative information regarding RHD\u2010related deaths in WA between 2012 and 2021 with qualitative interview data to identify system\u2010level opportunities for the prevention of RHD\u2010related mortality in the WA health care setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Using quantitative data from the WA RHD register, a descriptive analysis of the clinical and demographic characteristics of RHD patients aged &lt;\u200965\u2009years was conducted, stratified by vital status. Thematic qualitative analysis of RHD stakeholder interviews was conducted in parallel, capturing systemic factors perceived to prevent or contribute to RHD\u2010related mortality in WA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Limited health service contacts were documented for the 60 registered\u2010recorded deaths among people with RHD. Interviewees emphasised that access to appropriate care was vital to prevent mortality. Passionate healthcare providers connect patients with care by fostering trusting relationships, but logistical, socio\u2010cultural and care quality barriers continue to hamper connections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Systemic change is needed in WA to support motivated providers and ensure that efforts to reduce RHD mortality do not rely on individual initiatives. This study contributes evidence for the need to improve RHD program design by prioritising patient\u2010provider connections, empowering, and resourcing providers to effectively engage with RHD patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ajr.70022","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T05:25:57Z","timestamp":1741757157000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Connections Reduce Rheumatic Heart Disease\u2010Related Mortality in Western Australia: A Mixed Methods Study"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3707-5105","authenticated-orcid":false,"given":"Virginia","family":"DeCourcy","sequence":"first","affiliation":[{"name":"WA Country Health Service  Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Hunt","sequence":"additional","affiliation":[{"name":"Derbarl Yerrigan Health Service  Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Stacey","sequence":"additional","affiliation":[{"name":"Cardiovascular Epidemiology Research Centre University of Western Australia  Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Haynes","sequence":"additional","affiliation":[{"name":"Cardiovascular Epidemiology Research Centre University of Western Australia  Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverley","family":"Paterson","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health Australian National University  Canberra Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare","family":"Huppatz","sequence":"additional","affiliation":[{"name":"Department of Health Government of Western Australia  Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marisa","family":"Gilles","sequence":"additional","affiliation":[{"name":"WA Country Health Service  Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Katzenellenbogen","sequence":"additional","affiliation":[{"name":"Cardiovascular Epidemiology Research Centre University of Western Australia  Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,10]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0008990"},{"issue":"10","key":"e_1_2_13_3_1","first-page":"S3","article-title":"Ending Rheumatic Heart Disease in Australia: The Evidence for a New Approach","volume":"213","author":"Wyber R.","year":"2020","journal-title":"Medical Journal of Australia"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-021-00570-z"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2022-322146"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.114.001282"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.003498"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.020966"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.016851"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2021.113829"},{"key":"e_1_2_13_11_1","volume-title":"Deficit Discourse and Strengths\u2010Based Approaches: Changing the Narrative of Aboriginal and Torres Strait Islander Health and Wellbeing","author":"Fogarty W.","year":"2018"},{"key":"e_1_2_13_12_1","volume-title":"The 2020 Australian Guideline for Prevention, Diagnosis and Management of Acute Rheumatic Fever and Rheumatic Heart Disease","author":"RHD Australia","year":"2020"},{"key":"e_1_2_13_13_1","volume-title":"The RHD Endgame Strategy: The Blueprint to Eliminate Rheumatic Heart Disease in Australia by 2031","author":"END RHD Centre of Research Excellence","year":"2020"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19084650"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17041347"},{"key":"e_1_2_13_16_1","volume-title":"Findings of Inquest Into the Deaths of RHD Doomadgee Cluster","author":"Wilson N.","year":"2023"},{"key":"e_1_2_13_17_1","volume-title":"Record of Investigation Into Death of Mr. Yeeda","author":"Fogliani R. 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