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Rheumatic heart disease (RHD) is a condition that many nurses have heard of but little may have had direct experience in treating. RHD, like other chronic heart conditions, has a high long-term fatality rate. Nurses need to have a keen eye to notice symptoms, risk factors and implement preventative measures to address the disease.
At the Australian College of Nursing (ACN), nurses studying the Graduate Certificate in Paediatric Nursing Studies can gain these skills and knowledge to support First Nations children with RHD in a culturally-competent, family-centred manner.
ACN Nurse Educator and Coordinator for Paediatric Nursing Studies, Fran Stoddart sat down with us to go through everything nurses need to know about rheumatic heart disease.
For those who don’t know what rheumatic heart disease is, what is it and how does it affect us?
RHD is a preventable disease that disproportionately affects First Nations people in regional & remote Australia. Despite having been eliminated in the non-Indigenous Australian population for decades, RHD continues to devastate First Nations communities at some of the highest rates in the world.
The disease results from an abnormal autoimmune response to infectious diseases such as a group A streptococcal infection of the throat, known as ‘strep throat’. Acute rheumatic fever (ARF) is a progression of this response and is the precursor to RHD. ARF progressively damages the heart and leads to irreversible valve damage, heart failure and premature death.
The incidence of ARF and RHD are highest in Australian First Nations women and young people aged 5–14yrs.
Why do we still see high prevalence of rheumatic heart disease in First Nations children and young people?
RHD is a disease of disadvantage. First Nations people who live in regional and remote communities often live in crowded households, without essential hygiene infrastructure such as hot water, running showers and washing machines. A lack of access makes healthy living practices such as washing hands, clothes, and bodies difficult to achieve.
Living remotely also means that routine access to quality health care is not available. The result of this is frequent infection and reinfection with Streptococcus A, which is often missed due to a lack of regular health surveillance.
While data from 2021 shows that 92% of people diagnosed with ARF or RHD were First Nations Australians, it is important to note that the condition occurs in non-indigenous Australian populations who similarly have overcrowded standards of living. Knowing that, the high rates in First Nations communities means nurses working with First Nations communities need to know the symptoms and risk factors for the disease.
What do nurses need to know about ARF/RHD?
Nurses need to educate themselves regarding this disease. RHD exists in developing nations and indigenous communities, and it is a preventable disease exacerbated by poverty.
Rheumatic heart disease is a condition which affects 40 million people worldwide. Every year, it claims more than 300,000 lives, accounting for nearly two per cent of all deaths from cardiovascular disease. As cardiovascular disease is the number one cause of death globally, it is critical we reduce all preventable cases of heart disease. RHD most commonly occurs in childhood and can lead to early death or life-long disability.
What is the nursing role in addressing RHD?
Nurses are critical to empowering First Nations communities in their own self-determination. First Nations communities know what needs to be done to combat this disease, however they need support to increase housing availability and hygiene infrastructure.
Nurses are also needed to support increasing the numbers of Indigenous healthcare providers, to participate in health surveillance of children and young people, train Indigenous healthcare providers and assist in the resourcing of primary health teams and telehealth services.
Nurses can also educate the community on the role of preventative measures, and support the communities’ efforts to improve housing availability and hygiene infrastructure.
The main role of nurses is to provide culturally safe and respectful nursing care to the children and young people in these communities.
What can nurses do to address rheumatic heart disease and are there prevention strategies?
The best way of addressing RHD is to educate other nurses and the communities it affects. Nurses are well placed to provide community education regarding the spread of Streptococcus A in children, such as the signs and symptoms of strep infection in the throat, tonsils or skin.
For broader health care workers looking to find information and guidelines about AFR/RHD, there is a suite of information at Rheumatic Heart Disease Australia.
How does the Graduate Certificate in Paediatric Nursing Studies help support nurses to address rheumatic heart disease?
The Graduate Certificate in Paediatric Nursing Studies addresses the education of registered nurses on ARF and RHD in the Core paediatric subjects Foundations of Paediatric Nursing and Principles of Acute Paediatric Nursing.
Many resources developed by First Nations peoples are provided, and the students are encouraged to research this condition in relation to other ‘Close the Gap’ health topics.
Continuing professional development is particularly important to ensure we are all up-to-date with the latest developments and information in this space.
Final thoughts
For nurses looking for more information on RHD, they can visit the ‘End Rheumatic Heart Disease Centre of Research Excellence’ (END RHD CRE). END RHD CRE was established in 2014 to address the urgent need for a comprehensive, evidence-based plan to eliminate rheumatic heart disease (RHD) across Australia. The RHD Endgame Strategy is a blueprint for a project designed to end RHD in Australia by 2031. It is the result of collaboration between researchers, First Nation leaders, communities and people with lived experience.
Fran Stoddart
Fran Stoddart is a paediatric nurse who is passionate about her specialty, and her profession. Her career in nursing spans 40 years and includes clinical experience in paediatrics and paediatric critical care. She has worked in various substantive nursing roles as an expert clinician and nurse educator. In these roles, Fran contributed to policy and clinical guideline development and practice development initiatives. Fran is a strong advocate for closing the gap in First Nations health and is an active member of the ACN Reconciliation Action Plan Working Group.
Reference List:
Wyber R., Noonan K., Halkon C., et al. (2020). The RHD Endgame Strategy: A Snapshot. The blueprint to eliminate rheumatic heart disease in Australia by 2031. Perth: The END RHD Centre of Research Excellence, Telethon Kids Institute, 2020
Marijon, E., Mirabel, M., Celermajer, D. S., & Jouven, X. (2012). Rheumatic heart disease. Lancet (London, England), 379(9819), 953–964. https://doi.org/10.1016/S0140-6736(11)61171-9
World Heart Federation (n.d.). Rheumatic Heart Disease. https://world-heart-federation.org/what-we-do/rheumatic-heart-disease/#:~:text=Rheumatic%20heart%20disease%20is%20a,death%20or%20life%2Dlong%20disability.
Katzenellenbogen, J. M., Bond-Smith, D., Ralph, A. P., Wilmot, M., Marsh, J., Bailie, R., & Matthews, V. (2020). Priorities for improved management of acute rheumatic fever and rheumatic heart disease: analysis of cross-sectional continuous quality improvement data in Aboriginal primary healthcare centres in Australia. Australian health review: a publication of the Australian Hospital Association, 44(2), 212–221. https://doi.org/10.1071/AH19132
Ralph, A. P., Noonan, S., Wade, V., & Currie, B. J. (2021). The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease. The Medical Journal of Australia, 214(5), 220–227. https://doi.org/10.5694/mja2.50851
Rheumatic Heart Disease Australia (2012). What is acute rheumatic fever and rheumatic heart disease? (pp. 2). Darwin: Rheumatic Heart Disease Australia. https://healthinfonet.ecu.edu.au/key-resources/resources/23794/?title=What+is+ acute+rheumatic+fever+and+rheumatic+heart+disease%3F&contentid=23794_1
Woldu, B., & Bloomfield, G. S. (2016). Rheumatic Heart Disease in the Twenty-First Century. Current cardiology reports, 18(10), 96. https://doi.org/10.1007/s11886-016-0773-2
AIHW (2023). 1.06 Acute rheumatic fever and rheumatic heart disease. AIHW Indigenous Health Performance Framework. https://www.indigenoushpf.gov.au/measures/1-06-arf-rhd#references
