Abstract
Each year, more than 150 New Zealanders die of rheumatic heart disease (RHD). New Zealanders of Māori and Pacific ethnicity are up to ten times more likely to die of RHD than non-Māori/Pacific New Zealanders. The prevalence of RHD peaks in the 20-59 year age group, while mortality from this disease is most likely to occur in middle age (mortality rate for 50-59 age group: Māori 28 per 100,000; Pacific 18 per 100,000, non-Māori/Pacific 1 per 100,000).
RHD is the cardiac consequence of acute rheumatic fever (ARF). At the root of ARF is an immune response to streptococcal infection (typically Group-A streptococcus, or GAS), the results of which may include joint pain, rashes, abnormal movements (chorea) and endocarditis. It is the last of these consequences which may permanently damage heart valves, and it is this manifestation which is the primary characteristic of RHD. This valvular damage can lead to debilitating chronic heart disease, heart failure and consequent increased risk of mortality.