World Heart Federation publishes position statement on rheumatic fever, rheumatic heart disease

World Heart Federation position statement published online in Nature Reviews Cardiology

The World Heart Federation has published a new position statement outlining the five key strategic targets required to meet its strategic goal for rheumatic heart disease (RHD) - a 25% reduction in premature deaths from rheumatic fever (RF) and RHD among individuals aged <25 years by the year 2025.

RHD remains the most common cardiovascular disease in young people aged <25 years. RF and RHD have been almost eradicated in areas with establish economies. But RF and RHD are endemic in developing countries and are also common in poorer populations in middle-income countries (e.g. Brazil, India), as well as some indigenous populations in wealthy countries (Australia, New Zealand). Moreover, migration from low-income to high-income settings might be responsible for a new burden of RHD in high-income countries where the disease has been largely eliminated.

Conservative estimates indicate that there are between 15.6 and 19.6 million existing cases of RHD and its been estimated that there are around 252,000 new cases each year. Moreover, an estimated 233,000 to 468,164 individuals die from RHD each year, and hundreds of thousands of people are disabled by this disease and its long-term complications.

"RF and RHD are neglected diseases that require immediate attention," Professor Bongani Mayosi, Groote Schuur Hospital and University of Cape Town, South Africa; and Chair of the World Heart Federation Working Group on Rheumatic Fever and Rheumatic Heart Disease. "This position paper will form the platform for a detailed operational plan to address the barriers to RF and RHD control. The operational plan will be founded on science, research and quantifiable progress indicators to impact positively on millions of individuals with RHD."

A number of barriers have been identified that are currently preventing the control of RF and RHD.

• Neglect of RF and RHD - there is a relative lack of engagement in disease control by governments, civil society, patient advocates and funding agencies.
• Scarcity of data and scientific knowledge - Contemporary data is scarce. The current global figure for RHD mortality is speculative and likely to be a gross underestimate. But, descriptive and prognostic epidemiological data outlining disease prevalence, mortality and morbidity are critical for developing realistic targets and key performance indicators towards disease control.
• Research - Global research priorities for RF and RHD have been identified but there is a great need for resource allocation to conduct robust research into these priorities.
• Vaccines - a GAS vaccine is required for effective population-level primary prevention of RF is needed. GAS vaccine development and human testing has been underway for nearly a century with fluctuating enthusiasm. Few pharmaceutical companies have active internal programmes.
• Access to health care - Barriers exist to optimal primary, secondary and tertiary (medical and surgical care). Many patients around the world do not have access to the treatments they need at all stages of management.

The primary aim of this position paper is to serve as a guide on how to achieve the objective of controlling RHD and eliminating RF. Five strategic targets have been identified:

1. Comprehensive register-based control programmes
2. Global access to benzathine penicillin G
3. Identification and development of public figures as 'RHD champions'
4. Expansion of RHD training hubs
5. Support for vaccine development

Moreover, this document is intended to provide the foundation for governments, civil society, patient advocates, clinicians, researchers and funding agencies to develop partnerships and unify global efforts to control RF and RHD.