Acute Rheumatic Fever Follow-up

Updated: Nov 04, 2018
  • Author: Robert J Meador, Jr, MD; Chief Editor: Herbert S Diamond, MD  more...
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Follow-up

Further Outpatient Care

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  • Periodic monitoring at 3- to 4-month intervals is critical to evaluate for progress with the resumption of physical activity, resolution of the constitutional symptoms, and freedom from adverse effects from medications.

  • Less frequent visits, perhaps once a year, are appropriate while following a prophylaxis regimen.

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Transfer

Transfer to a short-term–care facility should be arranged when patients have active life-threatening sequelae, notably carditis.

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Deterrence/Prevention

Patients should be educated to seek medical attention upon the first signs of pharyngitis. Once the disease is established, patients should be educated regarding benefits and risks of compliance with their medical regimen, which may be protracted.

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Complications

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  • Acute episodes are self-limited, with an average duration of 3 months for untreated attacks. Recurrence tends to occur within the first few years of the attack.

  • The outcome of carditis is likely to be more severe if patients have pre-existing heart disease. Carditis resolves without sequelae in 65-75% of patients.

  • Severe cardiac failure, total disability, and death may occur years after the acute attack.

  • The risk of developing a new episode is highest during the 5 years following an acute attack. This justifies prophylaxis for all patients for at least 5 years or until the patient reaches age 18 years.

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Prognosis

The course followed by a patient after a first attack is highly variable and unpredictable. Approximately 90% of episodes last less than 3 months. Only a minority persist longer, in the form of unremitting rheumatic carditis or prolonged chorea.

In an Australian study, recurrence of ARF occurred most often in the first year after initial ARF episode (incidence 3.7 per 100 person-years), but low-level risk persisted for more than 10 years. Risk of progression to rheumatic heart disease was also highest in the first year (incidence 35.9), almost 10 times higher than that of ARF recurrence. [27]

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