Acute rheumatic fever/rheumatic heart disease (ARF/RHD) register: example of priority based guidelines*
| *Adapted from the Northern Territory Rheumatic Heart Disease Register 2003, with permission. |
| Priority 1: severe disease |
| Established RHD with any of: |
| • A valvar lesion that is severe |
| • A moderate to severe valvar lesion where left ventricular (LV) function is impaired or LV size is increased |
| • A moderate to severe valvar lesion where there is shortness of breath, tiredness, oedema, angina, or syncope |
| • History of bioprosthetic valve replacement (porcine or homograft), valve repair, valvotomy or metallic prosthetic valve replacement (until stabilised) |
| Management: |
| • Management by a cardiologist and consideration for surgery |
| • Patients should be reviewed every 6 months by a specialist physician or paediatrician |
| Priority 2: moderate disease |
| Established RHD with any of: |
| • A valvar lesion that is moderate, providing there are no symptoms and left ventricular function is normal |
| • Mechanical prosthetic valves once stable following surgery |
| • A child or adolescent with a history of chorea until 18 years old, even if there is no valve damage (>50% will subsequently develop valve disease) |
| Management: |
| • Managed by primary care doctor with review by specialist physician/paediatrician every year (or earlier if clinical deterioration) or within 3 months of hospital discharge following any episode of confirmed or suspected ARF |
| • Echocardiogram recommended every year (children) or 2 years (adults) to assess valve lesion severity and LV function |
| Priority 3: mild disease |
| RHD or ARF: |
| • A valvar lesion that is trivial to mild |
| • History of ARF with no evidence of RHD |
| Management: |
| • Managed by primary care doctor unless clinical deterioration. Children and adolescent up to 18 years reviewed every year by a specialist physician or paediatrician |
| • Echocardiogram every 2 years (children) or 5 years (adults, no recent ARF). |
| • Any new diagnosis of ARF always requires specialist physician/paediatrician follow up within 3 months of hospital discharge to assess progress |
| • Specialist physician review before ceasing secondary prophylaxis |