title: Rheumatic Heart Disease in the Twenty-First Century.
abstract: Rheumatic heart disease (RHD) is a chronic valvular disease resulting after severe or repetitive episodes of acute rheumatic fever (ARF), an autoimmune response to group A Streptococcus infection. RHD has been almost eliminated with improved social and health infrastructure in affluent countries while it remains a neglected disease with major cause of morbidity and mortality in many low- and middle-income countries, and resource-limited regions of high-income countries. Despite our evolving understanding of the pathogenesis of RHD, there have not been any significant advances to prevent or halt progression of disease in recent history. Long-term penicillin-based treatment and surgery remain the backbone of a RHD control program in the absence of an effective vaccine. The advent of echocardiographic screening algorithms has improved the accuracy of diagnosing RHD and has shed light on the enormous burden of disease. Encouragingly, this has led to a rekindled commitment from researchers in the most affected countries to advocate and take bold actions to end this disease of social inequality.
authors: Vanderbilt Institute for Global Health, Vanderbilt University, 2525 West End Avenue, Suite 750, Nashville, TN, 37203, USA.
authors: Bethel
authors: B
authors: Woldu
authors: Duke Clinical Research Institute, Duke University, 2400 Pratt Street, Durham, NC, 27705, USA. gerald.bloomfield@duke.edu.
authors: Gerald S
authors: GS
authors: Bloomfield
mesh_terms: D000900:Anti-Bacterial Agents / Q000600:supply & distribution / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D003906:Developing Countries; D018450:Disease Progression; D019983:Guideline Adherence; D006292:Health Priorities; D006301:Health Services Needs and Demand; D006801:Humans; D058069:Neglected Diseases; D010401:Penicillin G Benzathine / Q000600:supply & distribution / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000458:organization & administration*; D058996:Quality Improvement; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D055502:Secondary Prevention / Q000458:organization & administration*; D013297:Streptococcus pyogenes / Q000472:pathogenicity*
chemical_list: D000900:Anti-Bacterial Agents; D010401:Penicillin G Benzathine
keywords: Acute rheumatic fever; Rheumatic heart disease