rheumatic heart disease worldwide · pdf file rf = rheumatic fever rhd = rheumatic heart...

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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

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Successful completion of this CME activity, which includes participation in

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Rheumatic Heart Disease Worldwide: JACC Scientific Expert Panel will be

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

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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

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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

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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