Rheumatic Heart Disease
PAEDIATRIC
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If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
- Suspected Acute Rheumatic Fever.
- Acute arthritis (swollen hot joint with inability to use/ weight bear). Differential diagnosis includes septic arthritis and juvenile chronic arthritis.
- Migratory poly arthralgia
- New murmur in child aged 3- 16 years with signs of cardiac failure – increased respiratory rate, increased heart rate, enlarged heart and liver on examination, fatigue/ exercise intolerance on history.
- Child with chorea
- Living in an ARF-endemic setting
- Aboriginal and/or Torres Strait Islander peoples living in rural or remote settings
- Aboriginal and/or Torres Strait islander peoples, and Māori and/or Pacific Islander peoples living in metropolitan households affected by crowding and/or lower socioeconomic status
- Personal history of ARF/RHD and aged <40 years
For a child in a high-risk population there is a lower threshold for referral.
At high-risk
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- Refer to local HealthPathways or local guidelines
- The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition)
- Queensland Primary Clinical Care Manual
- Training resources available on RHD Australia website.
- Queensland RHD Register and Control Program
- ARF and RHD are notifiable diseases in Queensland. Medical and nurse practitioners have a legal duty to provide particular information on a patient when they become aware that the patient has, or is being treated for, ARF and/or RHD. For further details and the notification form, go to the Department of Health website or contact the Queensland RHD Register and Control Program.
- In the majority of cases, it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
- Next of kin or person(s) who is legally responsible for patient consent, with the exception of children under guardianship orders with the Department of Child Safety, Seniors and Disability Services, should be present at the first outpatient appointment.
- If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services
- Statement of intent – the prioritisation of health services for children and young people in the child protection system
- Rheumatic Fever resources
Clinician resources
| Category 1 (appointment within 30 calendar days) |
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| Category 2 (appointment within 90 calendar days) |
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| Category 3 (appointment within 365 calendar days) |
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Please insert the below information and minimum referral criteria into referral
1. Reason for request Indicate on the referral
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can't order, or the patient can't afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
2. Essential referral information Referral will be returned without this
- Reasons for suspecting rheumatic heart disease
- Confirmation of OOHC (where appropriate)
3. Additional referral information Useful for processing the referral
Highly desirable information – may change triage category.
- Aboriginal or Torres Strait Islander or Māori status (rheumatic fever risk)
- Family History of ARF/RHD
- History of GAS infection -throat or skin
- Examination findings –Observations Temp, HR Resp rate. Findings on examination of joints and heart. Presence of chorea. Skin features of ARF.
- Investigations – For possible new ARF: FBE, ESR, CRP, ASOT, Anti-DNase B. Throat swab for culture, swab for culture of any infected skin lesions, ECG (if possible), Echocardiogram (but should not delay referral if not available)
4. Request
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Patient's Demographic Details
- Full name (including aliases)
- Date of birth
- Residential and postal address
- Telephone contact number/s – home, mobile and alternative
- Medicare number (where eligible)
- Name of the parent or caregiver (if appropriate)
- Preferred language and interpreter requirements
- Identifies as Aboriginal and/or Torres Strait Islander
Referring Practitioner Details
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
Relevant clinical information about the condition
- Presenting symptoms (evolution and duration)
- Physical findings
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- Body mass index (BMI)
- Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
Reason for request
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can't order, or the patient can't afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
Clinical modifiers
- Impact on employment
- Impact on education
- Impact on home
- Impact on activities of daily living
- Impact on ability to care for others
- Impact on personal frailty or safety
- Identifies as Aboriginal and/or Torres Strait Islander
Other relevant information
- Willingness to have surgery (where surgery is a likely intervention)
- Choice to be treated as a public or private patient
- Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
Last updated: 3 December 2024
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