Contemporary Specialist Care for Rheumatic Heart Disease Meets New Zealand Heart Foundation Recommendations for Most Patients in Tāmaki Makaurau

Abstract

The World Health Organization endorses registries as a valuable adjunct to managing rheumatic heart disease (RHD). This study evaluated the management of New Zealand RHD Registry patients from 2010 to 2019 and alignment to New Zealand Heart Foundation Guidelines. A retrospective audit was undertaken of 150 patients in Tāmaki Makaurau, randomly selected from the New Zealand RHD Registry, with a review of frequency of specialist follow-up and echocardiograms, documentation regarding benzathine penicillin G, dental care, and anticoagulation post-surgery. There were 61 individuals with moderate RHD and 89 with severe RHD. Follow-up data were available for 128 of 150 (85%) patients who attended one or more specialist appointment. Of these, median duration between specialist appointments was 14 months and 8 months for moderate and severe, respectively (range to 8 years). Mean duration between echocardiograms was 21 months and 12 months for moderate and severe, respectively. Benzathine penicillin G prophylaxis was documented in 95 of 150 (63%) clinic letters and dental care was discussed in 99 of 150 (66%). Among 46 patients on warfarin, 13 (39%) had one or more hospitalisations due to INR control, bleeding, or thrombosis. The interval between specialist appointments and echocardiograms in patients with RHD in Auckland conforms with best practice guidelines; however, the wide range and the 15% with no documented follow-up highlight that some patients are not being seen at timely intervals. Benzathine penicillin G prophylaxis and dental treatment were discussed at most clinic appointments. Hospitalisation for anticoagulation complications occurred in nearly 40% of those on warfarin, highlighting the need for improved anticoagulation services for individuals following mechanical valve surgery.