RHD priority status at most recent assessment

A person’s priority status (Table 3.1) determines the recommended care plan to meet their medical and personal needs. This status may change over time as their condition and needs change. Priority definitions changed from the 2012 guidelines to the 2020 guidelines. Some people now require ongoing management that was not previously recommended. Both definitions are explained in Table 3.1. The time of application of these changes may vary between jurisdictions.

Priority 1 is assigned to people at greatest risk of disease recurrence/ exacerbation, and requires the most frequent follow up. Priority 4 is assigned to people with the lowest risk disease, and involves the least frequent follow up.

Table 3.1: Priority definitions
Priority level2012 Guideline2020 Guideline
Priority 1
  • Severe valvular disease or
  • Moderate/severe valvular lesions with symptoms or
  • Mechanical prosthetic valves; tissue prosthetic valves & valve repairs including balloon valvuloplasty
  • Severe RHD of any valve or
  • High risk post-valve surgical patients or
  • ≥ 3 episodes of ARF within the last 5 years or
  • Pregnant women with RHD (of any severity) may be considered Priority 1 for the duration of the pregnancy or
  • Children ≤ 5 years of age with ARF or RHD
Priority 2
  • Any moderate valve lesion in the absence of symptoms and with normal LV function
  • Moderate RHD of any valve or
  • Mild RHD involving both aortic and mitral valves or
  • Moderate risk post-valve surgical patients
Priority 3
  • ARF with no evidence of RHD or
  • Trivial to mild valvular disease
  • Mild RHD involving only a single valve or
  • ARF (probable or definite), currently prescribed secondary prophylaxis or
  • Borderline RHD currently prescribed secondary prophylaxis or
  • Low risk post-valve surgical patients
Priority 4
  • Patients with a history of ARF (no RHD) for whom secondary prophylaxis has been ceased
  • History of ARF (possible, probable or definite) and completed secondary prophylaxis or
  • Borderline RHD not on secondary prophylaxis or
  • Resolved RHD and completed secondary prophylaxis

Source: Adapted from The Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease 2020.

At the end of 2022, of the 5,424 First Nations people diagnosed with RHD and living in Qld, WA, SA or NT, 4,384 (81%) had a priority status recorded at their most recent evaluation. Of the 4,384 people, 24% (1,054 people) were priority 1, 22% (944) were priority 2, 47% (2,061) were priority 3, and 7.4% (325) were priority 4 (Supplementary tables 3.5a and 3.6).

There were 24 people living in NSW with a diagnosis of RHD and who had a current priority status recorded. Priority 3 was the most common priority status (Supplementary Table 3.6).