Can rheumatic heart disease be eliminated by 2036?

The state government's Rheumatic Heart Disease Strategic Framework 2026-2036 hopes to achieve this goal through Aboriginal-led prevention, equitable care and collaboration. However, there is plenty of detail yet to be determined.

The Department of Health said the framework provides a guide for health professionals, researchers, and communities to drive meaningful and sustainable change for rheumatic heart disease (RHD).

The condition refers to permanent heart valve damage caused by an inflammatory response, known as acute rheumatic fever (ARF), to untreated group A Streptococcus infections. Aboriginal people continue to experience the greatest impact of the disease.

While there is no cure for RHD it can be prevented. The framework aims to do so by looking at prevention opportunities from social and environmental factors, primary and secondary care, through to medical and surgical intervention for people with existing RHD.

However, there are no clear targets set out in framework.

Dr Helena Viola, Heart Foundation general manager for WA, said while there were several positive and evidence-informed priorities, the Foundation would like to see greater detail about how elimination would be achieved.“We would welcome an implementation roadmap outlining how actions will be translated into practice, including responsibilities, milestones, accountability mechanisms and measures of success,” she said.

Dr Viola said it should also be accompanied by a commitment to fund implementation of the strategy, with regular reporting on progress and outcomes.

The Department of Health was unable to provide key performance indicators (KPIs) that would be used to measure success of the framework's objectives.

A spokesperson said an implementation plan for the framework was being developed, which would include detail on KPIs.

"Progress against the KPIs will be reviewed regularly to ensure the framework remains aligned with its intended outcomes, efforts are sustained, and responsive to any emerging needs, evidence and innovation," they said.

They said funding would come from various Commonwealth and state sources.

"The WA Future Health Research and Innovation Fund’s Spotlight Program plays an important role in supporting the implementation of the RHD Strategic Framework.

"The Spotlight Program has initially awarded $1 million to the End RHD WA partners (Aboriginal Health Council of WA, WA Country Health Service, The Kids Research Institute Australia) to develop an action plan for the RHD Strategic Framework."

A further $24 million was expected to be put towards implementation following state government review of the action plan.

Health Minister Meredith Hammat said RHD remained one of the state's most significant yet preventable public health challenges.

“Too many West Australians continue to live with the long-term consequences of a disease that should no longer occur," she said.

“This framework is designed to close the gap in RHD outcomes for Aboriginal people, ensuring every person regardless of where they live has access to the health care they need.”

Clinicians should keep in mind

Dr Viola, who is a cardiovascular biochemist, said while the implementation plan was being developed, there were a number of considerations for doctors to keep in mind, especially those working in areas where ARF and RHD remain prevalent.

"ARF and RHD disproportionately affect First Nations peoples and communities experiencing social disadvantage, overcrowded housing and barriers to healthcare access," she said.

“Early treatment of Strep A throat and skin infections remains critical. However, skin infections may be normalised in some communities, which can delay presentation and complicate prevention efforts."

Dr Viola said RHD was frequently identified when the disease had progressed, including when people presented with advanced symptoms or during pregnancy.

"A significant proportion of new diagnoses occur when disease is already severe, highlighting the importance of early detection, follow-up and secondary prevention," she said.

"Clinicians play a critical role in supporting delivery of long-term penicillin prophylaxis, supporting continuity of care and helping people navigate what is often a complex and lifelong condition."

She said ongoing training and support for healthcare professionals working in rural and remote settings was essential to ensure timely recognition, diagnosis and management of ARF and RHD.

National ARF and RHD Guidelines and education and training modules are available from the Heart Foundation.