Diagnosis and Management of Acute Rheumatic Fever and Rheumatic Heart Disease

©2007 World Heart Federation … Updated October 2008

Diagnosis and Management of Acute Rheumatic Fever

and

Rheumatic Heart Disease


RHD Control Programmes


This presentation is intended to support the Curriculum for training health workers and others involved in the diagnosis and management of acute rheumatic fever and rheumatic heart disease.

It has been made possible thanks to the support of the Vodafone Group Foundation and the International Solidarity, State of Geneva, and the ongoing support of Menzies School of Health Research, Caritas Australia, Fiji Water Foundation, Cure Kids and Accor Hospitality.


WHO recommendations for RHD Control

A strong commitment from local Government

A committed and skilled RHD Advisory Group

An RHD Register of all people with confirmed and suspected ARF and RHD

A well-trained programme coordinator

Notification of ARF and RHD to the relevant health authority

Well-coordinated secondary prevention activities

A priority system to help deliver care to individuals at highest risk

Reliable resources including medications and laboratory support

Programmes established centrally and expanded regionally


Core Programme Objectives

Identify and register individuals with ARF and RHD

Standardise and improve delivery of secondary prophylaxis

Standardise diagnosis and management of ARF and RHD

Provide training and support for health workers

Provide support to the community

Report on the programme and rates of disease


Collect information on known cases of ARF & RHD

– Benzathine Penicillin injection books and clinic records

– Echocardiogram reports and cardiac surgery lists

– Hospital admission & death reports

Identify new cases

– Health centres or hospital when individuals present with ARF or RHD

– School health (screening) programmes

– Antenatal Clinics

Maintain a paper or computer register of all people with confirmed or suspected ARF & RHD

Objective 1 - Identify & Register cases


Establish secondary prophylaxis delivery

– Identify people who need secondary prophylaxis

– Identify health facilities where individuals receive secondary prophylaxis

Improve secondary prophylaxis – identify specific barriers to treatment

– Identify people who do not receive adequate Benzathine penicillin injections (>80% injections)

– Establish recall and reminder systems

– Support communication between health facilities

– Refer new cases to peripheral health facilities for ongoing management

– Identify people who move between health centres for treatment

Objective 2 - Optimise Secondary Prophylaxis


Standardise guidelines for diagnosis and management of ARF and RHD

– Revised Jones Criteria for diagnosis of ARF

– Standardise dosing and delivery of secondary prophylaxis

Train health workers

– Curriculum development

– Training programmes for students and trained staff

– Updates for staff in rural and remote areas

Communicate

– Referral of new cases to local community health facilities

– Update staff about on local ARF/ RHD issues

– Report on RHD in the community

Objective 3 – Training and Support for Health Workers


Educate and Inform

– Targeted education for people with ARF and RHD

– Community education materials (posters & brochures)

Manage individuals with ARF & RHD

– Promote ongoing medical care / echocardiogram / pregnancy counseling / dental care

Prioritise treatment for severe cases– Cardiac assessment

– Surgery and support

Objective 4 – Community Support


Screening may be undertaken when acute cases are identified and managed, and when

time and resources become available.

Considerations for screening– Who to screened (e.g. school children are easier / RHD may be more common in adults)

– Methods of diagnosis available (e.g. auscultation & clinical assessment, echocardiogram)

– Availability of trained staff

– Processes for reporting RHD cases to the RHD programme

– Health resources available for long-term management of more RHD cases.

Objective 5 – Screening for RHD


Lack of local resources (including dedicated staff)

Limited funds and other resources

Heavy workloads for primary care health staff

Priority of other health issues (e.g. TB, Malaria, HIV/AIDS, respiratory disease)

The RHD programme is complex

– Difficulties around communication with remote health facilities

– Limited travel to provide training & education

– Demanding data management

– Programme expanded too quickly

RHD Programme Difficulties


An RHD Programme should have

Local (Government) commitment

A manageable RHD Register

Well-trained, dedicated staff at all levels

Systems to identify known cases and refer of new cases

A priority system for severe cases

Secondary Prophylaxis monitoring and improvement

Ongoing support for health staff and the community.

Summary

Documents

Diagnosis and Management of Acute Rheumatic Fever and Rheumatic Heart Disease