A Retrospective Linked Data Analysis of Acute Rheumatic Fever and Rheumatic Heart Disease Diagnoses in Children Aged Under Five Years in Australia, 2001-2017.

OBJECTIVE: To describe the clinical and demographic profile of Australian children first diagnosed with acute rheumatic fever (ARF) or rheumatic heart disease (RHD) before the age of 5 years, with comparison to children aged 5-14 years. METHODS: Linked emergency department, hospitalisation, RHD register and death records from the End RHD in Australia: Study of Epidemiology were used to identify first ARF/RHD diagnosis occurring in < 15-year-olds. Demographic/clinical profiles and pre-diagnosis healthcare interactions were analysed with stratification into 5-year age groups. DESIGN: Retrospective cross-sectional linked administrative data analysis. SETTING: Northern Territory, South Australia, Queensland and Western Australia. PARTICIPANTS: Children aged < 15 years at first hospitalisation or notification for ARF or RHD, 2001-2017. MAIN OUTCOME MEASURES: Disease stage and severity at diagnosis, register notification status, clinical history prior to ARF or RHD diagnosis. RESULTS: Of 2382 children diagnosed with ARF/RHD aged < 15 years, 180 (7.6%) were aged under 5 years. Among under 5-year-olds with ARF or RHD, 30.6% had not been notified to RHD registers. A total 49 under 5-year-olds were diagnosed with RHD; with 22 (44.9%) classified as having mild disease, 16 (32.7%) moderate and 6 (12.2%) severe. High hospitalisation rates for injury in the first year of life were observed for the < 5-year-old cohort with ARF/RHD. CONCLUSIONS: We present the first comprehensive Australian evidence that ARF and RHD diagnoses are occurring in Australian children aged under 5 years. Greater awareness among clinicians is needed regarding ARF/RHD as a potential diagnosis in this young, high risk age group.