SOCIETY:N

HF

National Heart Foundation of Australia

New Guideline – Acute RheumaticFever and Rheumatic Heart Disease

Traven Lea, MAE ∗

National Manager, Aboriginal & Torres Strait Islander Program, National Heart Foundation of Australia

Acute rheumatic fever (ARF) and rheumatic heart dis-ease (RHD) occur at very high rates among indige-

nous Australians. These diseases affect young people, andare important causes of premature mortality. Almost allcases of RHD and associated deaths are preventable.

In contrast, ARF is now rare in other population groupsin Australia, and RHD in these groups occurs predomi-nantly in the elderly. Nonetheless, ARF still occurs fromtime to time in affluent populations, and the persistentlyhhp

F

Ta(tHunwt

g

•

•

•

pqlu

∗E

ically have had the most limited access to health care. Theguideline aims to ensure that these populations receivethe same standard of care as that available to other peoplein Australia.

Rigorous development

The writing group of the new guideline is composed of:Dr. Alex Brown, Dr. Jonathan Carapetis (Chair), Dr. Keith

igh rates of ARF in some middle class regions of the USA1

ighlight the need to remain aware of this disease in allopulations.

irst best practice guideline

he National Heart Foundation of Australia (NHFA)nd the Cardiac Society of Australia and New ZealandCSANZ) have jointly developed aGuideline for the Preven-ion andManagement of Acute Rheumatic Fever and Rheumaticeart Disease in Australian Indigenous Populations. This doc-ment is aimed at a wide audience including medical,ursing, allied health and Aboriginal health workers, asell as public health staff and policy makers. It is aimed

o be launched in early 2006.The first of its kind in ARF and RHD in Australia, the

Edwards, Dr. Clive Hadfield, Prof. Dianna Lennon, Ms.Lynette Purton, Dr. Andrew Tonkin, Dr. Warren Walsh,Dr. Gavin Wheaton and Dr. Nigel Wilson.

In developing the manuscript, the writing groupincluded recent developments and controversies in dis-ease management (see box).

In line with National Health Medical Research Council(NHMRC) specifications, this guideline includes levels ofevidence and accompanying grades of recommendation.

Key issues addressed in thenewARF/RHDguideline

• Need for different criteria for the diagnosis of ARFin high-risk compared to low-risk populations.

• Use of corticosteroids in the treatment of ARF.

uideline aims to:

outline the standard of care in the management of

• Use of echocardiography in the diagnosis and mon-itoring of patients with ARF and RHD.

• Timing of referral for valve surgery in RHD.

R

patients once they develop ARF or RHD, which shouldbe available to all persons in Australia;serve as a useful reference for clinicians, to becomequickly aware of the clinical and population healthneeds relating to ARF and RHD;update clinicians in aspects where current understand-ing may be incorrect, or where current managementstrategies may not be in line with the available evidence.

The strategies for preventing RHD are proven, sim-le, cheap and cost-effective. However, they are not ade-uately implemented, particularly in the Australian popu-

ations at highest risk of the disease. These populations aresually disadvantaged, live in remote settings and histor-

Tel.: +61 7 3872 2514; fax: +61 7 3252 9697.-mail address: traven.lea@heartfoundation.com.au.

• Role of valve replacement compared to valve repairfor mitral and aortic valve disease.

• Importance of ARF/RHD registers and coordinatedcontrol programs.

The guideline does not address the issue of primaryprevention. The main aim is to provide guidance inthe management of patients who develop ARF orRHD.

eference

1. Veasy LG, Tani LY, Hill HR. Persistence of acute rheumaticfever in the intermountain area of the United States. J Pediatr1994;124:9–16.

1443-9506/04/$30.00doi:10.1016/j.hlc.2005.06.015