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  • Listen to this manuscript’s

    audio summary by

    JACC Editor-in-Chief

    Dr. Valentin Fuster.

    J O U R N A L O F T H E AM E R I C A N C O L L E G E O F C A R D I O L O G Y V O L . 7 2 , N O . 1 2 , 2 0 1 8

    ª 2 0 1 8 B Y T H E AM E R I C A N C O L L E G E O F C A R D I O L O G Y F O UN DA T I O N

    P U B L I S H E D B Y E L S E V I E R

    THE PRESENT AND FUTURE

    JACC SCIENTIFIC EXPERT PANEL

    Rheumatic Heart Disease Worldwide

    JACC Scientific Expert Panel

    David A. Watkins, MD, MPH,a,b,c Andrea Z. Beaton, MD,d Jonathan R. Carapetis, MBBS, PHD,e,f

    Ganesan Karthikeyan, MD, DM,g Bongani M. Mayosi, MBCHB, DPHIL,b,h Rosemary Wyber, MBCHB, MPH,e,i

    Magdi H. Yacoub, MD,j Liesl J. Zühlke, MBCHB, MPH, PHDb,c

    JACC JOURNAL CME/MOC/ECME

    This article has been selected as the month’s JACC CME/MOC/ECME

    activity, available online at http://www.acc.org/jacc-journals-cme by

    selecting the JACC Journals CME/MOC/ECME tab.

    Accreditation and Designation Statement

    The American College of Cardiology Foundation (ACCF) is accredited by

    the Accreditation Council for Continuing Medical Education to provide

    continuing medical education for physicians.

    The ACCF designates this Journal-based CME activity for a maximum

    of 1 AMA PRA Category 1 Credit(s)�. Physicians should claim only the

    credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in

    the evaluation component, enables the participant to earn up to 1 Medical

    KnowledgeMOC point in the American Board of Internal Medicine’s (ABIM)

    Maintenance of Certification (MOC) program. Participants will earn MOC

    points equivalent to the amount of CME credits claimed for the activity. It is

    the CME activity provider’s responsibility to submit participant completion

    information to ACCME for the purpose of granting ABIM MOC credit.

    Rheumatic Heart Disease Worldwide: JACC Scientific Expert Panel will be

    accredited by the European Board for Accreditation in Cardiology (EBAC)

    for 1 hour of External CME credits. Each participant should claim only

    those hours of credit that have actually been spent in the educational

    activity. The Accreditation Council for Continuing Medical Education

    (ACCME) and the European Board for Accreditation in Cardiology (EBAC)

    have recognized each other’s accreditation systems as substantially

    equivalent. Apply for credit through the post-course evaluation. While

    offering the credits noted above, this program is not intended to provide

    extensive training or certification in the field.

    Method of Participation and Receipt of CME/MOC/ECME Certificate

    To obtain credit for JACC CME/MOC/ECME, you must:

    1. Be an ACC member or JACC subscriber.

    ISSN 0735-1097/$36.00

    From the aDivision of General Internal Medicine, Department of Medicin bDepartment of Medicine, University of Cape Town and Groote Schuur Hosp

    diatrics, University of Cape Town and Red Cross War Memorial Children’s Ho

    Health System, Washington, DC; eTelethon Kids Institute, University of Wes fPrincess Margaret Hospital for Children, Perth, Western Australia, Australi

    Medical Sciences, New Delhi, India; hThe Deans Suite, Faculty of Health Sci

    Africa; iOffice of the Chief Scientist, The George Institute for Global Health

    Australia; and the jAswan Heart Centre, Aswan, Egypt. Dr. Watkins has receive

    2. Carefully read the CME/MOC/ECME-designated article available on-

    line and in this issue of the Journal.

    3. Answer the post-test questions. A passing score of at least 70%must be

    achieved to obtain credit.

    4. Complete a brief evaluation.

    5. Claim your CME/MOC/ECME credit and receive your certificate

    electronically by following the instructions given at the conclusion of the

    activity.

    CME/MOC/ECME Objective for This Article: Upon completion of this

    activity, the learner should be able to: 1) identify, within a global context,

    populations that remain at elevated risk of acute rheumatic fever and

    rheumatic heart disease; 2) summarize areas of consensus and the major

    gaps in evidence regarding the prevention and medical management of

    rheumatic heart disease; and 3) describe indications for catheter-based or

    surgical management of common rheumatic valvular lesions.

    CME/MOC/ECME Editor Disclosure: JACC CME/MOC/ECME Editor Raga-

    vendra R. Baliga, MD, FACC, has reported that he has no financial re-

    lationships or interests to disclose.

    Author Disclosures: Dr. Watkins has received support from the RHD Action

    grant from Medtronic Foundation outside of the submitted work.

    Dr. Carapetis has received funding from Novartis Institutes for Biomedical

    Research. Dr. Wyber has received funding from the Postgraduate Scholar-

    ship from the National Health and Medical Research Council (NHMRC),

    Australia, and from the Telethon Kids Institute. All other authors have

    reported that they have no relationships relevant to the contents of this

    paper to disclose.

    Medium of Participation: Print (article only); online (article and quiz).

    CME/MOC/ECME Term of Approval

    Issue Date: September 18, 2018

    Expiration Date: September 17, 2019

    https://doi.org/10.1016/j.jacc.2018.06.063

    e, University of Washington, Seattle, Washington;

    ital, Cape Town, South Africa; cDepartment of Pae-

    spital, Cape Town, South Africa; dChildren’s National

    tern Australia, Subiaco, Western Australia, Australia;

    a; gDepartment of Cardiology, All India Institute of

    ences, University of Cape Town, Cape Town, South

    , UNSW Sydney, Camperdown, New South Wales,

    d support from the RHD Action grant fromMedtronic

    http://www.acc.org/jacc-journals-cme https://doi.org/10.1016/j.jacc.2018.06.063 https://s3.amazonaws.com/ADFJACC/JACC7212/JACC7212_fustersummary_08 https://s3.amazonaws.com/ADFJACC/JACC7212/JACC7212_fustersummary_08 https://s3.amazonaws.com/ADFJACC/JACC7212/JACC7212_fustersummary_08 https://s3.amazonaws.com/ADFJACC/JACC7212/JACC7212_fustersummary_08 http://crossmark.crossref.org/dialog/?doi=10.1016/j.jacc.2018.06.063&domain=pdf

  • Watkins et al. J A C C V O L . 7 2 , N O . 1 2 , 2 0 1 8

    Present Status of Rheumatic Heart Disease S E P T E M B E R 1 8 , 2 0 1 8 : 1 3 9 7 – 4 1 6 1398

    Rheumatic Heart Disease Worldwide

    JACC Scientific Expert Panel

    David A. Watkins, MD, MPH,a,b,c Andrea Z. Beaton, MD,d Jonathan R. Carapetis, MBBS, PHD,e,f

    Ganesan Karthikeyan, MD, DM,g Bongani M. Mayosi, MBCHB, DPHIL,b,h Rosemary Wyber, MBCHB, MPH,e,i

    Magdi H. Yacoub, MD,j Liesl J. Zühlke, MBCHB, MPH, PHDb,c

    ABSTRACT

    Fo

    Dr

    (N

    rel

    Ma

    Rheumatic heart disease (RHD) is a preventable heart condition that remains endemic among vulnerable groups in many

    countries. After a period of relative neglect, there has been a resurging interest in RHD worldwide over the past decade.

    In this Scientific Expert Panel, the authors summarize recent advances in the science of RHD and sketch out priorities for

    current action and future research. Key questions for laboratory research into disease pathogenesis and epidemiological

    research on the burden of disease are identified. The authors present a variety of pressing clinical research questions on

    optimal RHD prevention and advanced care. In addition, they propose a policy and implementation research agenda that

    can help translate current evidence into tangible action. The authors maintain that, despite knowledge gaps, there is

    sufficient evidence for national and global action on RHD, and they argue that RHD is a model for strengthening health

    systems to address other cardiovascular diseases in limited-resource countries. (J Am Coll Cardiol 2018;72:1397–416)

    © 2018 by the American College of Cardiology Foundation.

    O ver the past decades, rheumatic heart dis-ease (RHD) and its antecedent rheumaticfever (RF) have largely disappeared from wealthy countries, and the clinical caseload of RHD has shifted to older age groups. RHD has also been dwarfed by ischemic heart disease. Additionally, RF/ RHD control programs were successfully implemented in some low- and middle-income countries during the latter part of the 20th century, prompting the World Health Organization (WHO) and others to downscale their RF/RHD activities by the early 2000s (1).

    Yet, RHD continues unabated in poor countries and among vulnerable groups in wealthy ones (2). A 2007 report on RHD among schoolchildren in Cambodia and Mozambique spawned a whole literature on echocar- diography and RHD (3). The recent REMEDY study (Global Rheumatic Heart Disease Registry) docu- mented high rates of disability and premature death across African and Asian countries (4). In 2015, a civil society movement, RHD Action, was launched to raise awareness and support countries looking to address RHD (5). In May 2018, the World Health Assembly adopted a resolution to reinvigorate global and na- tional RF/RHD prevention and control efforts (6).

    undation outside of the submitted work. Dr. Carapetis has received fundi

    . Wyber has received funding from the Postgraduate Scholarship from

    HMRC), Australia, and from the Telethon Kids Institute. All other auth

    evant to the contents of this paper to disclos

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