-
Lancet (London, England) Mar 2012Rheumatic heart disease, often neglected by media and policy makers, is a major burden in developing countries where it causes most of the cardiovascular morbidity and... (Review)
Review
Rheumatic heart disease, often neglected by media and policy makers, is a major burden in developing countries where it causes most of the cardiovascular morbidity and mortality in young people, leading to about 250,000 deaths per year worldwide. The disease results from an abnormal autoimmune response to a group A streptococcal infection in a genetically susceptible host. Acute rheumatic fever--the precursor to rheumatic heart disease--can affect different organs and lead to irreversible valve damage and heart failure. Although penicillin is effective in the prevention of the disease, treatment of advanced stages uses up a vast amount of resources, which makes disease management especially challenging in emerging nations. Guidelines have therefore emphasised antibiotic prophylaxis against recurrent episodes of acute rheumatic fever, which seems feasible and cost effective. Early detection and targeted treatment might be possible if populations at risk for rheumatic heart disease in endemic areas are screened. In this setting, active surveillance with echocardiography-based screening might become very important.
Topics: Child; Echocardiography; Humans; Rheumatic Fever; Rheumatic Heart Disease
PubMed: 22405798
DOI: 10.1016/S0140-6736(11)61171-9 -
Revista Da Sociedade Brasileira de... Mar 2019Rheumatic heart disease (RHD) remains a major cause of preventable death and disability in children and young adults. Despite significant advances in medical technology... (Review)
Review
Rheumatic heart disease (RHD) remains a major cause of preventable death and disability in children and young adults. Despite significant advances in medical technology and increased understanding of disease mechanisms, RHD continues to be a serious public health problem throughout the world, especially in low- and middle-income countries. Echocardiographic screening has played a key role in improving the accuracy of diagnosing RHD and has highlighted the disease burden. Most affected patients present with severe valve disease and limited access to life-saving cardiac surgery or percutaneous valve intervention, contributing to increased mortality and other complications. Although understanding of disease pathogenesis has advanced in recent years, key questions remain to be addressed. Preventing or providing early treatment for streptococcal infections is the most important step in reducing the burden of this disease.
Topics: Echocardiography; Humans; Rheumatic Heart Disease
PubMed: 30892546
DOI: 10.1590/0037-8682-0041-2019 -
Circulation Nov 2020The global burden of rheumatic heart disease continues to be significant although it is largely limited to poor and marginalized populations. In most endemic regions,... (Review)
Review
The global burden of rheumatic heart disease continues to be significant although it is largely limited to poor and marginalized populations. In most endemic regions, affected patients present with heart failure. This statement will seek to examine the current state-of-the-art recommendations and to identify gaps in diagnosis and treatment globally that can inform strategies for reducing disease burden. Echocardiography screening based on World Heart Federation echocardiographic criteria holds promise to identify patients earlier, when prophylaxis is more likely to be effective; however, several important questions need to be answered before this can translate into public policy. Population-based registries effectively enable optimal care and secondary penicillin prophylaxis within available resources. Benzathine penicillin injections remain the cornerstone of secondary prevention. Challenges with penicillin procurement and concern with adverse reactions in patients with advanced disease remain important issues. Heart failure management, prevention, early diagnosis and treatment of endocarditis, oral anticoagulation for atrial fibrillation, and prosthetic valves are vital therapeutic adjuncts. Management of health of women with unoperated and operated rheumatic heart disease before, during, and after pregnancy is a significant challenge that requires a multidisciplinary team effort. Patients with isolated mitral stenosis often benefit from percutaneous balloon mitral valvuloplasty. Timely heart valve surgery can mitigate the progression to heart failure, disability, and death. Valve repair is preferable over replacement for rheumatic mitral regurgitation but is not available to the vast majority of patients in endemic regions. This body of work forms a foundation on which a companion document on advocacy for rheumatic heart disease has been developed. Ultimately, the combination of expanded treatment options, research, and advocacy built on existing knowledge and science provides the best opportunity to address the burden of rheumatic heart disease.
Topics: American Heart Association; Cost of Illness; Female; Humans; Male; Practice Guidelines as Topic; Rheumatic Heart Disease; United States
PubMed: 33073615
DOI: 10.1161/CIR.0000000000000921 -
Journal of Cardiac Surgery Aug 2021Rheumatic heart disease (RHD) remains a neglected disease of poverty. While nearly eradicated in high-income countries due to timely detection and treatment of acute... (Review)
Review
Rheumatic heart disease (RHD) remains a neglected disease of poverty. While nearly eradicated in high-income countries due to timely detection and treatment of acute rheumatic fever, RHD remains highly prevalent in low- and middle-income countries (LMICs) and among indigenous and disenfranchised populations in high-income countries. As a result, over 30 million people in the world have RHD, of which approximately 300,000 die each year despite this being a preventable and treatable disease. In LMICs, such as in Latin America, sub-Saharan Africa, and Southeast Asia, access to cardiac surgical care for RHD remains limited, impacting countries' population health and resulting economic growth. Humanitarian missions play a role in this context but can only make a difference in the long term if they succeed in training and establishing autonomous local surgical teams. This is particularly difficult because these populations are typically young and largely noncompliant to therapy, especially anticoagulation required by mechanical valve prostheses, while bioprostheses have unacceptably high degeneration rates, and valve repair requires considerable experience. Devoted and sustained leadership and local government and public health cooperation and support with the clinical medical and surgical sectors are absolutely essential. In this review, we describe historical developments in the global response to RHD with a focus on regional, international, and political commitments to address the global burden of RHD. We discuss the surgical and clinical considerations to properly manage surgical RHD patients and describe the logistical needs to strengthen cardiac centers caring for RHD patients worldwide.
Topics: Cardiac Surgical Procedures; Humans; Leadership; Rheumatic Fever; Rheumatic Heart Disease
PubMed: 33938579
DOI: 10.1111/jocs.15597 -
International Journal of Cardiology Jan 2022
Topics: Cost-Benefit Analysis; Delayed Diagnosis; Humans; Rheumatic Fever; Rheumatic Heart Disease
PubMed: 34736979
DOI: 10.1016/j.ijcard.2021.10.158 -
JAMA Cardiology Apr 2021
Topics: Humans; Mass Screening; Rheumatic Heart Disease
PubMed: 33471062
DOI: 10.1001/jamacardio.2020.7063 -
Annals of Global Health 2021Rheumatic heart disease (RHD) is a complication of untreated throat infection by Group A beta-hemolytic streptococcus with a high prevalence among socioeconomically... (Review)
Review
Rheumatic heart disease (RHD) is a complication of untreated throat infection by Group A beta-hemolytic streptococcus with a high prevalence among socioeconomically disadvantaged populations. Despite its high incidence and prevalence, RHD prevention is not a priority in major global health discussions. The reasons for the apparent neglect are multifactorial, including underestimated morbidity and mortality burden, underappreciated economic burden, lack of public awareness, and lack of sustainable investment. In this review, we recommend multisectoral collaboration to tackle the burden of RHD by engaging the public, health experts, and policymakers; augmenting funding for clinical care; improving distribution channels for prophylaxis, and increasing research and innovation as critical interventions to save millions of people from preventable morbidity and mortality.
Topics: Global Health; Humans; Incidence; Prevalence; Rheumatic Heart Disease; Vulnerable Populations
PubMed: 34824991
DOI: 10.5334/aogh.3426 -
Global Heart 2021RHD in pregnancy (RHD-P) is associated with an increased burden of maternal and perinatal morbidity and mortality. A sequellae of rheumatic fever resulting in heart... (Review)
Review
RHD in pregnancy (RHD-P) is associated with an increased burden of maternal and perinatal morbidity and mortality. A sequellae of rheumatic fever resulting in heart valve damage if untreated, RHD is twice as common in women. In providing an historical overview, this commentary provides context for prevention and treatment in the 21 st century. Four underlying themes inform much of the literature on RHD-P: its association with inequities; often-complex care requirements; demands for integrated care models, and a life-course approach. While there have been some gains particularly in awareness, strengthened policies and funding strategies are required to sustain improvements in the RHD landscape and consequently improve outcomes. As the principal heart disease seen in pregnant women in endemic regions, it is unlikely that the Sustainable Development Goal 3 target of reduced global maternal mortality ratio can be met by 2030 if RHD is not better addressed for women and girls.
Topics: Female; Humans; Pregnancy; Rheumatic Fever; Rheumatic Heart Disease
PubMed: 35141125
DOI: 10.5334/gh.1079 -
BMC Health Services Research Nov 2017Rheumatic heart disease (RHD) is a chronic cardiac condition with an infectious aetiology, causing high disease burden in low-income settings. Affected individuals are... (Review)
Review
BACKGROUND
Rheumatic heart disease (RHD) is a chronic cardiac condition with an infectious aetiology, causing high disease burden in low-income settings. Affected individuals are young and associated morbidity is high. However, RHD is relatively neglected due to the populations involved and its lower incidence relative to other heart diseases.
METHODS AND RESULTS
In this narrative review, we describe how RHD care can be informed by and integrated with models of care developed for priority non-communicable diseases (coronary heart disease), and high-burden communicable diseases (tuberculosis). Examining the four-level prevention model (primordial through tertiary prevention) suggests primordial and primary prevention of RHD can leverage off existing tuberculosis control efforts, given shared risk factors. Successes in coronary heart disease control provide inspiration for similarly bold initiatives for RHD. Further, we illustrate how the Chronic Care Model (CCM), developed for use in non-communicable diseases, offers a relevant framework to approach RHD care. Systems strengthening through greater integration of services can improve RHD programs.
CONCLUSION
Strengthening of systems through integration/linkages with other well-performing and resourced services in conjunction with policies to adopt the CCM framework for the secondary and tertiary prevention of RHD in settings with limited resources, has the potential to significantly reduce the burden of RHD globally. More research is required to provide evidence-based recommendations for policy and service design.
Topics: Humans; Long-Term Care; Models, Theoretical; Primary Prevention; Rheumatic Heart Disease; Risk Factors
PubMed: 29187184
DOI: 10.1186/s12913-017-2747-5 -
Cell Biochemistry and Biophysics Jul 2015Rheumatic heart disease is a major problem in developing countries and is the cause of most of the cardiovascular mortality in young people, leading to about 250,000... (Review)
Review
Rheumatic heart disease is a major problem in developing countries and is the cause of most of the cardiovascular mortality in young people, leading to about 250,000 deaths per year worldwide. This disease results from an abnormal autoimmune response to group A streptococci infection in a genetically susceptible host. The acute rheumatic fever, the precursor to rheumatic heart disease, can affect various organs and lead to irreversible valve damage and heart failure. The antibiotic Penicillin is generally used for the treatment and prevention of this disease. The treatment guidelines have emphasized antibiotic prophylaxis against recurrent episodes of acute rheumatic fever which is feasible and cost effective. The early diagnosis and treatment is possible if people at risk for rheumatic heart disease in endemic areas are screened. An active surveillance with echocardiography based screening may be a useful program (Marijon et al., Lancet 379(9891):953-964, 2012). The use of vitamins, C and E, and natural antioxidants protect many heart diseases.
Topics: Humans; Rheumatic Heart Disease
PubMed: 25638346
DOI: 10.1007/s12013-015-0552-5