Special Global Heart Issue Explores Growing Global Prevalence of Rheumatic Heart Disease

Rheumatic heart disease (RHD) is preventable, but continues to cause death and illness in poorer countries, and there continues to be "no low- or middle-income countries with coordinated, national control programs," according to an editorial published as part of a Global Heart  series on the growing global prevalence of RHD.

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The authors of the editorial explain that RHD and rheumatic fever (RF) was a major focus in affluent countries between the 1970s and 1990s, and has since been nearly eliminated, however, "a new era has begun" with "regions where RF/RHD remains a major problem."

They note that there has been an increasing global effort to collaborate to eliminate RHD, but explain that "the major gap is one of implementation." "There is no doubt that, if we put into practice the knowledge we already have, the majority of deaths from RHD around the world, as well as the new cases that continue to occur, could be prevented right now. This requires implementation science, but it also requires advocacy, awareness, commitment, coordination, and resources," they add.

Jagat Narula, MD, PhD, MACC, co-author of the editorial and editor-in-chief of Global Heart, writes that "this issue [of Global Heart] calls into focus creative and innovative solutions for combating the consequences of the alarming burden of RHD." He says that this "urges the international community to make the prevention of RHD an obligatory component of the global action plan against non-communicable diseases (NCDs)" particularly as a part of national health programs in the sub-Saharan African region where the disease is widespread, and areas of Australia and New Zealand that have portions of their country experiencing widespread RHD.

A separate editorial explains that the prevalence of RHD might be higher than previously reported. Estimated to cause 233,000 deaths each year, the authors note that differences in methodology, and "an incomplete understanding of the relationship between echocardiographic detection of asymptomatic mild disease and progression to symptomatic disease" may contribute to the "imperfect" data. Moving forward, they call for a "new model for RHD epidemiologic studies" and "high quality and comprehensive data" to "better inform national, regional, and global control strategies."

Meanwhile, another editorial discusses the importance of echocardiography screening for RHD and presents results from several studies that show that "using echocardiography increases detection rates of both definite RHD cases and borderline cases.

They explain that "use of the 2012 World Heart Federation (WHF) criteria for echocardiograph diagnosis of RHD is strongly recommended," and that "portable echocardiography is a relatively new screening tool for RHD, which has raised awareness of the high prevalence of RHD in many countries." However, they add that moving forward, "the natural history of subclinical RHD needs further clarification."

"RHD is a highly preventable health problem which is destroying the lives of children and young persons from poor families," said K. Srinath Reddy, MD, DM, president of the WHF. "It continues to be neglected by health systems despite being one of oldest heart diseases known to medical science for centuries and methods of prevention, through penicillin therapy for streptococcal sore throat, have been available for several decades. It is time RF and RHD receive renewed attention to save hearts too young to die. Prevention of RF and treatment of RHD should be an integral component of the global action plan against NCDs and part of national programmes for universal health coverage.

Other editorials in the special issue look at the increasing awareness that an untreated sore throat can lead to RHD, how a supply of penicillin to treat strep throat can prevent RHD, the need for an awareness campaign in Sudan, and more.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Noninvasive Imaging, CHD & Pediatrics and Imaging, CHD & Pediatrics and Quality Improvement, Echocardiography/Ultrasound

Keywords: New Zealand, Africa South of the Sahara, Rheumatic Heart Disease, Rheumatic Fever, Sudan, National Health Programs, Penicillins, Scarlet Fever, Child, Prevalence, Pharyngitis, Epidemiologic Studies, Australia, Pharynx, Echocardiography

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