Determining risk of acute rheumatic fever to inform diagnosis

Determining whether or not a patient is at high risk of acute rheumatic fever is an important part of making the diagnosis (see Overview of diagnosis of acute rheumatic fever), but can be difficult. Detailed guidance is available from RHDAustralia1; if unsure, seek advice from a specialist with expertise in acute rheumatic fever.

An individual is at high risk of developing acute rheumatic fever if they are younger than 40 years and any one of the followingRHDAustralia (ARF/RHD writing group), 2020:

  • an Aboriginal and/or Torres Strait Islander person living in a rural or remote area
  • an Aboriginal and/or Torres Strait Islander person, or a Māori and/or Pacific person, living in a household affected by overcrowding or experiencing socioeconomic disadvantage
  • a person with a history of acute rheumatic fever or rheumatic heart disease
  • part of a family or household in which a member has a recent history of acute rheumatic fever or rheumatic heart disease.

For individuals younger than 40 years, but particularly between 5 and 20 years, other factors that could put them at high risk of developing acute rheumatic fever includeRHDAustralia (ARF/RHD writing group), 2020:

  • living in a household affected by overcrowding and experiencing socioeconomic disadvantage
  • current or prior residence in, or frequent or recent travel to, an Australian setting with a high rate of acute rheumatic fever2
  • current or prior residence in, or frequent or recent travel to, an international setting with a high rate of acute rheumatic fever (eg refugees, migrants)3.
1 See the RHDAustralia Guidelines and Diagnosis Calculator App.Return
2 In Australia, acute rheumatic fever is generally considered to be endemic in Far North Queensland and North Queensland, the Northern Territory, and the Pilbara and Kimberley regions of Western Australia; acute rheumatic fever rates may also be high in other remote areas of AustraliaKatzenellenbogen, 2020 RHDAustralia (ARF/RHD writing group), 2020.Return
3 Internationally, high rates of acute rheumatic fever occur in low- to middle-income countriesRHDAustralia (ARF/RHD writing group), 2020.Return