{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:55:49Z","timestamp":1790078149237,"version":"4.0.1"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2017,3]]},"abstract":"\n Background<\/jats:title>\n \n Rheumatic heart disease (\n RHD<\/jats:styled-content>\n ) remains a disease of international importance, yet little has been published about disease progression in a contemporary patient cohort. Multi\u2010state models provide a well\u2010established method of estimating rates of transition between disease states, and can be used to evaluate the cost\u2010effectiveness of potential interventions. We aimed to create a multi\u2010state model for\n RHD<\/jats:styled-content>\n progression using serial clinical data from a cohort of Australian patients.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n The Northern Territory\n RHD<\/jats:styled-content>\n register was used to identify all Indigenous residents diagnosed with\n RHD<\/jats:styled-content>\n between the ages of 5 and 24\u00a0years in the time period 1999\u20132012. Disease severity over time, surgeries, and deaths were evaluated for 591 patients. Of 96 (16.2%) patients with severe\n RHD<\/jats:styled-content>\n at diagnosis, 50% had proceeded to valve surgery by 2\u00a0years, and 10% were dead within 6\u00a0years. Of those diagnosed with moderate\n RHD<\/jats:styled-content>\n , there was a similar chance of disease regression or progression over time. Patients with mild\n RHD<\/jats:styled-content>\n at diagnosis were the most stable, with 64% remaining mild after 10\u00a0years; however, 11.4% progressed to severe\n RHD<\/jats:styled-content>\n and half of these required surgery.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n The prognosis of young Indigenous Australians diagnosed with severe\n RHD<\/jats:styled-content>\n is bleak; interventions must focus on earlier detection and treatment if the observed natural history is to be improved. This multi\u2010state model can be used to predict the effect of different interventions on disease progression and the associated costs.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.116.003498","type":"journal-article","created":{"date-parts":[[2017,3,2]],"date-time":"2017-03-02T21:10:51Z","timestamp":1488489051000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":69,"title":["Rheumatic Heart Disease Severity, Progression and Outcomes: A Multi\u2010State Model"],"prefix":"10.1161","volume":"6","author":[{"given":"Jeffrey","family":"Cannon","sequence":"first","affiliation":[{"name":"Telethon Kids Institute The University of Western Australia Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Roberts","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research Royal Darwin Hospital Campus Darwin Northern Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Milne","sequence":"additional","affiliation":[{"name":"NT Rheumatic Heart Disease Register Centre for Disease Control Darwin Northern Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan R.","family":"Carapetis","sequence":"additional","affiliation":[{"name":"Telethon Kids Institute The University of Western Australia Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.4.6.836"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.32.3.457"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.45.3.543"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e3181fbd85b"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu449"},{"key":"e_1_3_2_7_2","unstructured":"Australian Institute of Health and Welfare . Rheumatic heart disease and acute rheumatic fever in Australia: 1996\u20132012. Cat. no. CVD 60. 2013."},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.2010.01841.x"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.001477"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu131"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2712"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/0962280208092301"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1023\/A:1009672031531"},{"key":"e_1_3_2_14_2","volume-title":"Australian Guideline for Prevention, Diagnosis and Management of Acute Rheumatic Fever and Rheumatic Heart Disease","author":"RHD Australia (ARF\/RHD writing group) National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand","year":"2012","unstructured":"RHD Australia (ARF\/RHD writing group) National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand . Australian Guideline for Prevention, Diagnosis and Management of Acute Rheumatic Fever and Rheumatic Heart Disease. 2nd ed. Menzies School of Health Research: Darwin; 2012.","edition":"2"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(86)90122-0"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(94)70247-0"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.65.2.375"},{"key":"e_1_3_2_18_2","unstructured":"Australian Institute of Health and Welfare Field B. Rheumatic heart disease: all but forgotten in Australia except amongst Aboriginal and Torres Strait Islander peoples. AIHW Cat. No. AUS 48. 2004."},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.2012.02838.x"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.003495"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1586\/14737167.2013.852470"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.3111\/13696998.2015.1006366"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2012.157"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.116.003498","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T06:26:33Z","timestamp":1715581593000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.116.003498"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,3]]},"references-count":22,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2017,3]]}},"alternative-id":["10.1161\/JAHA.116.003498"],"URL":"https:\/\/doi.org\/10.1161\/jaha.116.003498","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,3]]},"assertion":[{"value":"2016-05-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-09-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-03-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e003498"}}