Evidence map›Paper›PMID 30018165›Full record

Trial reportJournal of the American Heart Association2018

Improving Delivery of Secondary Prophylaxis for Rheumatic Heart Disease in a High-Burden Setting: Outcome of a Stepped-Wedge, Community, Randomized Trial.

Anna P Ralph, Jessica L de Dassel, Adrienne Kirby, Clancy Read, Alison G Mitchell, Graeme P Maguire, Bart J Currie, Ross S Bailie, Vanessa Johnston, Jonathan R Carapetis

Open access · goldAbstract readClinical Trial, Phase IIIMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of the American Heart Association, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 5 pooled it
4.6field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 5 syntheses or guidelines pooled it, 55 citations in OpenAlex.

  1. Pooled it
  2. Audit and feedback: effects on professional practice.The Cochrane database of systematic reviews · 2025
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  17. Secondary Prophylaxis Among First Nations People With Acute Rheumatic Fever in Australia: An Integrative Review.Journal of transcultural nursing : official journal of the Transcultural Nursing Society · 2023
    Review
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  19. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 8 institutions in 1 country.

Anna P RalphMenzies School of Health Research, Darwin, Northern Territory, Australia anna.ralph@menzies.edu.au.
Jessica L de DasselCharles Darwin University, Darwin, Northern Territory, Australia.
Adrienne KirbyNational Health and Medical Research Council Clinical Trials Centre, University of Sydney, New South Wales, Australia.
Clancy ReadTelethon Kids Institute University of Western Australia, Perth, Western Australia, Australia.
Alison G MitchellMenzies School of Health Research, Darwin, Northern Territory, Australia.
Graeme P MaguireBaker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
Bart J CurrieMenzies School of Health Research, Darwin, Northern Territory, Australia.
Ross S BailieUniversity of Sydney University Centre for Rural Health, Lismore, New South Wales, Australia.
Vanessa JohnstonMenzies School of Health Research, Darwin, Northern Territory, Australia.
Jonathan R CarapetisTelethon Kids Institute University of Western Australia, Perth, Western Australia, Australia.
Menzies School of Health Research · AUAustralian National University · AUBaker Heart and Diabetes Institute · AUCharles Darwin University · AUNational Health and Medical Research Council · AUPrincess Margaret Hospital for Children · AUThe Kids Research Institute Australia · AUUniversity of Sydney · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHealth system strengthening is needed to improve delivery of secondary prophylaxis against rheumatic heart disease. METHODS AND

resultsWe undertook a stepped-wedge, randomized trial in northern Australia. Five pairs of Indigenous community clinics entered the study at 3-month steps. Study phases comprised a 12 month baseline phase, 3 month transition phase, 12 month intensive phase and a 3- to 12-month maintenance phase. Clinics received a multicomponent intervention supporting activities to improve penicillin delivery, aligned with the chronic care model, with continuous quality-improvement feedback on adherence. The primary outcome was the proportion receiving ≥80% of scheduled penicillin injections. Secondary outcomes included "days at risk" of acute rheumatic fever recurrence related to late penicillin and acute rheumatic fever recurrence rates. Overall, 304 patients requiring prophylaxis were eligible. The proportion receiving ≥80% of scheduled injections during baseline was 141 of 304 (46%)-higher than anticipated. No effect attributable to the study was evident: in the intensive phase, 126 of 304 (41%) received ≥80% of scheduled injections (odds ratio compared with baseline: 0.78; 95% confidence interval, 0.54-1.11). There was modest improvement in the maintenance phase among high-adhering patients (43% received ≥90% of injections versus 30% [baseline] and 28% [intensive],

conclusionsThis strategy did not improve adherence to rheumatic heart disease secondary prophylaxis within the study time frame. Longer term primary care strengthening strategies are needed. CLINICAL

trial registrationURL: www.anzctr.org.au. Unique identifier: ACTRN12613000223730.

Indexed as

Patient ComplianceQuality ImprovementAdolescentAdultAnti-Bacterial AgentsChildChild, PreschoolFemaleFollow-Up StudiesHumansIncidenceInjectionsMaleMiddle AgedNorthern TerritoryPenicillin G BenzathineAnti-Bacterial AgentsPenicillin G Benzathineacute rheumatic feveradherencecluster randomized trialquality improvementrheumatic heart diseasesystems of care

Identifiers

PMID30018165
PMCPMC6064833
OpenAlexW2884336002

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.