Since 2013, the acute rheumatic fever diagnosis and guideline app has been downloaded over 8,000 times. It can be used in a variety of clinical scenarios, and gives clinicians clear guidance in diagnosing acute rheumatic fever (ARF).

The tropical north of Australia has some of the highest recorded rates of ARF and rheumatic heart disease (RHD) in the world. Getting an accurate and timely diagnosis for ARF is essential to stopping the progression to RHD; a disease that leads to progressive disability, reduced quality of life, and premature death in young adults. For doctors working in the north, the free-to-use ARF diagnosis calculator is an essential medical app in the fight against ARF and RHD.

RHDAustralia sat down with Dr Ash Thomas, a registrar at Royal Darwin Hospital. We talked to her about the prevalence of ARF/RHD in the Northern Territory, how she came to find out about the app and the benefits of using the app. In her time working in the Territory, she’s come across many cases of ARF and relies on the app to ensure an accurate diagnosis is made in cases of suspected ARF.

Thanks for taking the time to talk with us Dr Thomas. Had you heard about ARF and RHD before you arrived in the Territory?

I studied medicine at James Cook University in Townsville and being a tropically situated University, ARF and RHD were taught as part of the curriculum.  But until I arrived in Darwin, I had never actually seen a case of ARF or RHD.  

When did you first see and treat someone with ARF and/or RHD?

It would have been during my placements working out in remote Indigenous communities in the Northern Territory. It was incredible to see all the people who were on the ARF/RHD registry and the large amount of people from the community who were on the injection list and recall system. That experience gave me an appreciation for the scale of the problem. In one of the communities, nearly half the population were receiving penicillin injections to prevent another case of ARF.

When did you first come across the app?

I first came across the ARF diagnosis app the year before my placements. I was on a paediatric rotation in my fifth year as a medical student, which would have been my first year at Royal Darwin Hospital. Paediatric Cardiologist, Dr Bo Remenyi, was showing us how to use it. I think it had just been rolled out as a new app and everyone was quite excited about putting it into practice.

Did you find it useful?

For the last couple of years, I had mostly adult clients as part of my residency with the infectious diseases unit. Normally first presentations of ARF occur in 5 to 14 year-olds, and they tend to present with symptoms such as joint pains and fevers. But with adults, because of their age, and what seemed to be a broader and more varied set of symptoms, it made diagnosis more difficult. Because we were getting a lot of new suspected cases in adults, I found it useful to go back through the app to make sure I was on the right path in my diagnosis. In cases where it wasn’t ARF, it was reassuring to know you’ve ticked off that box and then you can work your way through trying to figure out whatever else it may be.  

Dr Ash Thomas is a registrar at Royal Darwin Hospital. Her previous work experience includes time as an intern and resident at Royal Darwin Hospital and placements in some of Northern Territory’s remote Indigenous communities. She’s worked under paediatric cardiologist Dr Bo Remenyi and Director of Infectious Diseases Professor Bart Currie.

There is no definitive test to identify ARF, and signs and symptoms vary - the diagnosis calculator helps clinicians with this complex diagnosis.