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Evaluation of the American Heart Association 2015 revised Jones criteria versus existing guidelines
  1. Dinesh Kumar1,
  2. Euden Bhutia1,
  3. Pradeep Kumar2,
  4. Binoy Shankar1,
  5. Atul Juneja3,
  6. Sudha Chandelia1
  1. 1Department of Paediatrics, PGIMER and associated Dr Ram Manohar Lohia Hospital, New Delhi, India
  2. 2Department of Pediatrics and Neonatology, Rani Children's Hospital, Ranchi, India
  3. 3Department of Biostatistics, National Institute of Medical Statistics (ICMR), Delhi, India
  1. Correspondence to Dr Dinesh Kumar, Division of Paediatric Cardiology, Department of Paediatrics, PGIMER and associated Dr Ram Manohar Lohia Hospital, Room no 238, OPD Block, New Delhi 110001, India; dineshkumar169{at}yahoo.co.in

Abstract

Objectives To compare the diagnostic yield of acute rheumatic fever (ARF) by the American Heart Association/ American College of Cardiology (AHA/ACC) 2015 revised Jones criteria with the WHO 2004 and Australian guidelines 2012.

Methods Retrospective observational study in 93 cases of suspected ARF admitted to the Division of Paediatric Cardiology between January 2012 and December 2014. WHO 2004, Australian guidelines and AHA/ACC 2015 Jones criteria were applied to assess definite and probable ARF.

Results Of the 93 cases, 50 were diagnosed as the first episode of ARF and 43 as a recurrence of the condition. Subclinical carditis was a predominant presentation (38%) in the first episode group (p<0.01) whereas in the recurrence group carditis (88%) was the main presentation (p<0.01). Among the joint manifestations, the majority of patients in both the first episode group and the recurrence group presented with arthralgia. Of all the patients with suspected ARF (50), 34% of cases did not fulfil the standard Jones criteria 2004; however, 86% qualified as having ARF on applying the Australian and AHA/ACC 2015 criteria. Surprisingly in the recurrence group only 67% of the patients fulfilled AHA/ACC 2015 despite the modifications incorporated beyond WHO 2004; however, all the patients fulfilled the Australian guidelines either as definite (88.4%) or probable (11.6%). Inclusion of subclinical carditis, polyarthralgia and monoarthritis as major criteria influenced the diagnosis to definite ARF in 20%, 10% and 4% of patients, respectively.

Conclusions The clinical manifestations of ARF, comprising subclinical carditis and arthralgia, are possibly milder in the Indian population; hence, inclusion of subclinical carditis, polyarthralgia and monoarthritis as major criteria in the newer guidelines has improved the diagnostic yield of ARF. In the absence of a gold standard for the diagnosis of ARF, it is not possible to comment on sensitivity and specificity.

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