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Objective: Rheumatic heart disease (RHD) comprises heart-valve damage caused by acute rheumatic fever (ARF). The Australian Government Rheumatic Fever Strategy funds RHD Control Programs to support detection and management of ARF and RHD. We assessed epidemiological changes during the years of RHD Control Program operation., Methods: Linked RHD register, hospital and death data from four Australian jurisdictions were used to measure ARF/RHD outcomes between 2010 and 2017, including: 2-year progression to severe RHD/death; ARF recurrence; secondary prophylaxis delivery and earlier disease detection., Results: Delivery of secondary prophylaxis improved from 53% median proportion of days covered (95%CI: 46-61%, 2010) to 70% (95%CI: 71-68%, 2017). Secondary prophylaxis adherence protected against progression to severe RHD/death (hazard ratio 0.2, 95% CI 0.1-0.8). Other measures of program effectiveness (ARF recurrences, progression to severe RHD/death) remained stable. ARF case numbers and concurrent ARF/RHD diagnoses increased., Conclusions: RHD Control Programs have contributed to major success in the management of ARF/RHD through increased delivery of secondary prevention yet ARF case numbers, not impacted by secondary prophylaxis and sensitive to increased awareness/surveillance, increased., Implications for Public Health: RHD Control Programs have a major role in delivering cost-effective RHD prevention. Sustained investment is needed but with greatly strengthened primordial and primary prevention., Competing Interests: Conflicts of interest The authors have no conflicts of interest to declare., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objective: Hospitalization for atrial fibrillation (AF) is a large and growing public health problem. We examined current trends in the incidence, prevalence, and associated mortality of first-ever hospitalization for AF., Methods: Linked hospital admission data were used to identify all Western Australia residents aged 35-84 years with prevalent AF and incident (first-ever) hospitalization for AF as a principal or secondary diagnosis during 1995-2010., Results: There were 57,552 incident hospitalizations, mean age 69.8 years, with 41.4% women. Over the calendar periods, age- and sex-standardized incidence of hospitalization for AF as any diagnosis declined annually by 1.1% (95% CI; 0.93, 1.29), while incident AF as a principal diagnosis increased annually by 1.2% (95% CI; 0.84, 1.50). Incident AF hospitalization was higher among men than women, and 15-fold higher in the 75-84 compared with 35-64 year age group. The age- and sex-standardized prevalence of AF increased annually by 2.0% (95% CI; 1.88, 2.03) over the same period. Comorbidity trends were mixed with diabetes and valvular heart disease increasing, and hypertension, coronary artery disease, heart failure, cerebrovascular disease, and chronic kidney disease decreasing. The 1-year all-cause mortality after incident AF hospitalization declined from 17.6% to 14.6% (trend P<0.001), with an adjusted hazard ratio of 0.86 (95% CI; 0.81, 0.91)., Conclusion: This contemporary study shows that incident AF hospitalization is not increasing except for AF as a principal diagnosis, while population prevalence of hospitalized AF has risen substantially. The high 1-year mortality following incident AF hospitalization has improved only modestly over the recent period., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: The prevalence of hospitalised atherothrombotic disease affecting the coronary, cerebrovascular and peripheral vasculature is expected to increase due to improving survival, ageing and changing risk factor profiles. This study determined sex, age-standardised and age-specific (35-54, 55-69, 70-84years) prevalence of atherothrombotic disease and its association with diabetes and chronic kidney disease in Western Australian residents from 2000 to 2007., Methods: In a cross-sectional and longitudinal study, person-linked hospitalisations for atherothrombotic disease were obtained using records from 1985. From 2000 to 2007, total and vasculature-specific prevalence of atherothrombotic disease (as a principal diagnosis) was calculated using a 15-year lead-in to determine prior disease and comorbidity., Results: In 2007, 45,916 (8.6%) men and 22,782 (4.3%) women in Western Australia had established atherothrombotic disease and about 25% had diabetes, 10% had chronic kidney disease, and 5% had both. From 2000 to 2007 the estimated average annual change in age-standardised atherothrombotic disease prevalence was -0.6%/year (95% CI -0.8, -0.4) in men and -0.7%/year (95% CI -1.0, -0.4) in women. Similar modest declines were seen in age-standardised prevalence of monovascular and polyvascular atherothrombotic disease. The proportion of cases with diabetes increased by about 5%/year, the proportion having chronic kidney disease increased slowly in women (1.5%/year) and was stable in men, and the proportion with both comorbidities increased at about 9%/year., Conclusion: The age-standardised prevalence of atherothrombotic disease requiring hospitalisation has been in marginal decline in Western Australia this decade, despite the proportion of affected persons with diabetes and/or chronic kidney disease steadily rising., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)