Rheumatic Heart Disease

It is a sad reality that although eminently preventable, and despite possessing such knowledge for >70 years, rheumatic heart disease (RHD) remains the most common cause of cardiovascular morbidity and early mortality in young people worldwide. A disease of the poor, RHD is one of the most neglected diseases. Several challenges are unique to the acute rheumatic fever/RHD continuum and contribute to its persistence, including its sequestration among the poorest, its protracted natural history, the erratic availability of penicillin, and the lack of a concerted effort in endemic regions. However, there is cause for optimism following a resurgence in scientific interest over the last 15 years. This review presents the latest advancements in epidemiology, diagnosis, and management. It also discusses pressing research questions on disease pathophysiology, the barriers to implementation of effective management strategies, and pragmatic policy solutions required for translation of current knowledge into meaningful action. (J Am Coll Cardiol 2023;81:81-94)(c) 2023 by the American College of Cardiology Foundation.

Automated summary

Despite possessing knowledge for over 70 years, rheumatic heart disease (RHD) remains the most common cause of cardiovascular morbidity and early mortality in young people worldwide. RHD is a neglected disease that is prevalent among the poorest populations. Challenges such as limited access to penicillin and lack of concerted efforts in endemic regions contribute to its persistence. However, there is optimism due to increased scientific interest in the past 15 years.