Ending rheumatic heart disease in Australia: the evidence for a new approach

Rosemary Wyber, Katharine Noonan, Catherine Halkon, Stephanie Enkel, Jeffrey Cannon, Emma Haynes, Alice G Mitchell, Dawn C Bessarab, Judith M Katzenellenbogen, Daniela Bond-Smith, Rebecca Seth, Heather D’Antoine, Anna P Ralph, Asha C Bowen, Alex Brown and Jonathan R Carapetis, on behalf of the END RHD CRE Investigators and Collaborators
Med J Aust 2020; 213 (10): S1-S31. || doi: 10.5694/mja2.50853
Published online: 16 November 2020


  • The RHD Endgame Strategy: the blueprint to eliminate rheumatic heart disease in Australia by 2031 (the Endgame Strategy) is the blueprint to eliminate rheumatic heart disease (RHD) in Australia by 2031. Aboriginal and Torres Strait Islander people live with one of the highest per capita burdens of RHD in the world.
  • The Endgame Strategy synthesises information compiled across the 5-year lifespan of the End Rheumatic Heart Disease Centre of Research Excellence (END RHD CRE). Data and results from priority research projects across several disciplines of research complemented literature reviews, systematic reviews and narrative reviews. Further, the experiences of those working in acute rheumatic fever (ARF) and RHD control and those living with RHD to provide the technical evidence for eliminating RHD in Australia were included.
  • The lived experience of RHD is a critical factor in health outcomes. All future strategies to address ARF and RHD must prioritise Aboriginal and Torres Strait Islander people’s knowledge, perspectives and experiences and develop co-designed approaches to RHD elimination. The environmental, economic, social and political context of RHD in Australia is inexorably linked to ending the disease.
  • Statistical modelling undertaken in 2019 looked at the economic and health impacts of implementing an indicative strategy to eliminate RHD by 2031. Beginning in 2019, the strategy would include: reducing household crowding, improving hygiene infrastructure, strengthening primary health care and improving secondary prophylaxis. It was estimated that the strategy would prevent 663 deaths and save the health care system $188 million.
  • The Endgame Strategy provides the evidence for a new approach to RHD elimination. It proposes an implementation framework of five priority action areas. These focus on strategies to prevent new cases of ARF and RHD early in the causal pathway from Streptococcus pyogenes exposure to ARF, and strategies that address the critical systems and structural changes needed to support a comprehensive RHD elimination strategy.

For the full Supplement, please download the PDF.

Provenance: Commissioned; externally peer reviewed.

  • Rosemary Wyber1,2
  • Katharine Noonan2
  • Catherine Halkon2
  • Stephanie Enkel2
  • Jeffrey Cannon2
  • Emma Haynes3
  • Alice G Mitchell4
  • Dawn C Bessarab3
  • Judith M Katzenellenbogen2,3
  • Daniela Bond-Smith3
  • Rebecca Seth2,3
  • Heather D’Antoine4
  • Anna P Ralph4
  • Asha C Bowen2,5
  • Alex Brown6,7
  • Jonathan R Carapetis2,5
  • on behalf of the END RHD CRE Investigators and Collaborators

  • 1 George Institute for Global Health, Sydney, NSW.
  • 2 Telethon Kids Institute, Perth, WA.
  • 3 University of Western Australia, Perth, WA.
  • 4 Menzies School of Health Research, Darwin, NT.
  • 5 Perth Children’s Hospital, Perth, WA.
  • 6 South Australian Health and Medical Research Institute, Adelaide, SA.
  • 7 University of South Australia, Adelaide, SA.


  • Children, families and communities living with RHD — We thank the Aboriginal and Torres Strait Islander people for sharing their stories in the Endgame Strategy, and acknowledge that the research and data in this publication reflect the experiences of Aboriginal and Torres Strait Islander people and communities affected by the ongoing trauma of ARF and RHD.
  • END RHD Review Working Group — We thank the following members of the END RHD Alliance, who formed an expert working group to review content of the Endgame Strategy for feasibility and acceptability, including review from a cultural perspective: Kate Armstrong, Lorraine Anderson, Karrina DeMasi, John Havnen, Imran Mansoor, A Merritt, Elizabeth Moore, Vicki Wade and Angela Young.
  • END RHD CRE — We thank the following investigators: Jonathan Carapetis, Bart Currie, Graeme Maguire, Dawn Bessarab, Dan McAullay, Heather D’Antoine, Alex Brown, Andrew Steer, Nick de Klerk, Vicki Krause, David Atkinson, Gavin Wheaton, Thomas Snelling, Anna Ralph, Rebecca Slade, Rosemary Wyber, Samantha Colquhoun, Christopher Reid and Claire Boardman.
  • Content experts — We thank the following reviewers, who contributed technical expertise to relevant sections of the Endgame Strategy report: Ross Bailie, Julie Bennett, Hilary Bloomfield, Pasqualina Coffey, Ellen Donnan, Michelle Dowden, Mark Engel, Josh Francis, Caterina Giorgi, Kate Hardie, Emma Haynes, Adam Heaton, David Hendrickx, Ari Horton, Anna-Louise Kimpton, Matthew Lester, James Marangou, Malcolm McDonald, Tracy McRae, Nirrumbuk Environmental Health and Services, Sara Noonan, Glenn Pearson, Simon Quilty, Benjamin Reeves, Boglarka Reményi, Kathryn Roberts, Rosalie Schultz, Nicola Slavin, Mike Stephens, Melissa Stoneham, Paul Torzillo and Geraldine Vaughan.
  • Technical support — we thank the following people for providing technical support: Jessica de Dassel, Charlize Donovan, Elizabeth Eadie-Mirams, Kate Harford, Tamara Hunter and Stephanie Pegler.

Funding: The Endgame Strategy was produced with the support of the END RHD CRE, which is funded by a National Health and Medical Research Council (NHMRC) grant (grant number 1080401). Data collection and analysis were also funded by the NHMRC (grant number 1146525).

Competing interests:

No relevant disclosures.


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