What are the recommended follow-up protocols for patients with rheumat

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

For patients with rheumatic heart disease, follow-up protocols primarily focus on monitoring for cardiac complications, often aligning with guidelines for heart valve disease and chronic heart failure.

Initial Specialist Referral and Assessment:

Adults with moderate or severe valve disease of any type, or bicuspid aortic valve disease of any severity (including mild), should be offered referral to a specialist .
People with heart failure due to valve disease should be referred for specialist assessment and advice regarding follow-up .
Pregnant women or women considering pregnancy with moderate or severe valve disease, bicuspid aortic valve disease (any severity with associated aortopathy), or a prosthetic valve should be referred to a cardiologist with expertise in pregnant women's care, regardless of symptoms . Specialist care should be shared between a cardiologist and obstetrician if pregnancy is considered or occurs ,.

General Follow-up and Monitoring for Heart Failure (Common Complication):

All people with chronic heart failure require regular follow-up and monitoring ,.
Heart failure care should be delivered by a dedicated multidisciplinary team, which may include a dedicated heart failure nurse and a pharmacist .
The frequency of follow-up needs to be individualized based on symptom severity, stability, treatment, and comorbidities .
The follow-up interval should be short (days to 2 weeks) if the person's clinical condition or drugs have changed .
For stable conditions, follow-up should occur at least every 6 months . This includes a clinical assessment, medication review, and assessment of renal function ,.
Clinical Assessment and Monitoring:

Assess functional capacity (e.g., using New York Heart Association classification), fluid status, cardiac rhythm (minimum of examining the pulse), cognitive status, and nutritional status ,.
Ask about palpitations, shortness of breath, presence of oedema, and syncopal/presynopal symptoms .
If syncope or presyncope occurs (unless clearly due to postural hypotension), refer to a cardiologist .
If an arrhythmia is suspected, arrange a 12-lead ECG or 24-hour ECG monitoring .
Assess fluid status by checking for changes in body weight, oedema (abdomen, sacrum, genitalia, ankles), raised jugular venous pressure, fine lung crepitations, hepatomegaly, and postural drop in blood pressure .
Monitor serum urea, electrolytes, and estimated glomerular filtration rate (eGFR) every 6 months .
Consider monitoring N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) levels in people less than 75 years of age to guide optimum drug treatment, especially for those with a higher baseline NT-pro-BNP level (greater than 2114 pg/mL) .

Medication Review:

Review the person's medications, including over-the-counter preparations, and ask about possible adverse effects ,.
For people taking amiodarone, offer liver and thyroid function tests and a review of side effects as part of their routine 6-monthly clinical review .
For people with heart failure and atrial fibrillation, follow the recommendations on anticoagulation in the NICE guideline on atrial fibrillation . In people with heart failure in sinus rhythm, anticoagulation should be considered for those with a history of thromboembolism, left ventricular aneurysm, or intracardiac thrombus . Be aware of the effects of impaired renal and liver function on anticoagulant therapies .

Preventive Measures and Holistic Care:

Offer an annual influenza vaccine and a once-only pneumococcal vaccination ,.
Screen for depression and anxiety . Reassess psychological status once the physical condition has stabilized if depression is likely to have been precipitated by heart failure symptoms .
If suitable, ensure the person has been offered referral to a supervised exercise-based group rehabilitation programme for people with heart failure, which should include psychological and education-based components .
Assess nutritional status; consider dietetic referral if BMI is under 18.5 kg/m2, or give advice on healthy weight if BMI is over 30 kg/m2 .
Provide general information about heart failure and its management, including self-care advice . Ensure sources of information and advice have been given to the person and their carers/family .
Offer a discussion about advance care planning and advance decisions, if appropriate, at an early stage of the disease .

What are the recommended follow-up protocols for patients with rheumatic heart disease to monitor for cardiac complications?

Key References

What are the recommended follow-up protocols for patients with rheumatic heart disease to monitor for cardiac complications?

Key References

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