Action on Rheumatic Heart Disease
What is Rheumatic Heart Disease?
Rheumatic heart disease (RHD) is a preventable, treatable disease that affects over 15.6
million people around the world and kills 500,000 of them each year. It afflicts the world’s
poorest, most marginalized populations and imposes heavy costs on the health systems
that can least afford it. If left untreated, rheumatic heart disease can lead to heart valve
damage, stroke, heart failure and death. In endemic countries, this preventable disease
is a stark measure of health system failure and inequality.
Who does Rheumatic Heart
Disease affect?
RHD is the most common acquired heart disease in young people under the age of 25.
It most often begins in childhood. If left untreated, RHD may progress to serious heart
damage that kills or debilitates adolescents and young adults, and makes pregnancy
hazardous. Although virtually eliminated in Europe and the Americas, the disease remains
common in Africa, the Middle East, Central and South Asia, the South Pacific and in
impoverished pockets of other regions.
What causes
Rheumatic Heart
Disease?
Like cervical or stomach cancer,
RHD is a non-communicable disease
that is caused by an infection. In those
who are susceptible, a streptococcal
sore throat develops into rheumatic
fever (RF), which then damages heart
valves, resulting in RHD. There is no
cure for RHD, but symptoms can be
managed with regular injections of
antibiotics. Without this systematic
control, RHD can result in stroke,
heart failure and death.
Two stories from the Pacific
Pacemaca, a 7-year-old girl from Fiji, had been taken to the local hospital 15 times over
the course of 18 months. Her complaints of swollen joints and shortness of breath were
initially attributed to pneumonia. On her sixteenth visit to the local hospital, a nurse
who had attended a RHD workshop run by the World Heart Federation recognized
the symptoms of RHD. Pacemaca was immediately transferred to the main hospital,
but it was too late to save her. She died three hours later. Had Pacemaca’s RHD been
diagnosed earlier, she would have been able to control her disease with penicillin and
would probably have survived.
Malaki (not real name) was 8 years old when he was diagnosed with RHD in Samoa.
His family received education from the dedicated RHD nurse and he is careful to take
his monthly penicillin injections to avoid needing heart surgery. Today, he remains
healthy and plays rugby for his school team. Samoa typically spends 15% of its entire
health budget sending patients abroad for heart surgery – many cannot go due to lack
of funds. Malaki makes sure to visit his doctor regularly to reduce his chance of requiring
surgery (see photo).
World Heart Federation
2751 WHF RHD Leaflet ART.indd 1
www.worldheart.org
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Action on Rheumatic Heart Disease
Why are people still dying?
Access to health care:
• Healthcare provision is often weakest in the places most
affected by RHD
• Patients may be unable to cover expensive out-of-pocket
costs in seeking medical help
• When provided, RHD health services can drain resources
from other health areas.
Detection:
What is the World Heart
Federation doing?
The WHF is working with governments, the World Health
Organization, international bodies and the private sector to reduce
deaths from RHD by 25% by 2025 for people under the age of 25.
How:
• Encouraging endemic countries to integrate RHD prevention
and control into national health plans
• Identifying ways to strengthen healthcare systems and equip
• Communities can be poorly educated in the causes or
symptoms of RF/RHD and may not seek medical attention for
sore throats
• Healthcare workers are often untrained in prevention or early
detection of the disease
• The most accurate detection of RHD relies on
echocardiography, which is expensive, hard to transport,
and requires training.
healthcare providers to prevent and treat RHD
• Funding projects in resource-poor areas to scale up efforts to
tackle RHD
• Convening experts to share best practice and strategies to
combat RHD
• Raising awareness of RHD and the need to treat sore throats
• Promoting Universal Health Coverage to improve access to
services and reduce impoverishment from RHD.
Management:
• RHD can be managed by monthly injections of antibiotics
(Benzathine Penicillin G or BPG), but this requires systematic
recordkeeping and follow-up
• BPG quality and supply are unreliable, and the injections
are painful
• Late-stage RHD can require complex heart surgery,
Get involved
Whatever your background, you have the power to help us eliminate
RHD in endemic regions across the world. The RHD community is
at a pivotal stage and needs the following support:
Health Ministers
Take steps to integrate RHD into existing
NCD and national health plans
Advocates
Raise awareness and showcase the need to
integrate RHD into other development areas
Health
Professionals
Support your organization’s efforts to
prevent and control RHD
Private Sector
Share best practice on improving the supply
of antibiotics, and support innovation in
vaccine development and technology
which is expensive and often has poor outcomes.
Lack of political will to help:
• The world has known how to prevent and control RHD for
50+ years, but has lacked political will to eliminate it
• Primordial causes of RHD – poor sanitation, poor housing,
overcrowding – have not been remedied
• Until the RHD Action Alliance was established in 2015,
there has been little global commitment to this issue.
How to prevent and control Rheumatic
Heart Disease
Primordial prevention: Improvement of environmental
and socio-economic conditions of populations at risk of
RF and RHD.
Primary prevention: Treatment of sore throat with
antibiotics to reduce the incidence of RF.
Secondary prevention: Use of antibiotics to reduce
the recurrence of RF, which can lead to RHD.
Tertiary prevention: Medical and surgical treatment
of the complications of RF and RHD.
World Heart Federation
2751 WHF RHD Leaflet ART.indd 2
About the World Heart Federation
The World Heart Federation speaks and acts on behalf of
its global membership to prevent and control cardiovascular
disease (CVD). Using local insights from our Members,
we combine leading science with life-changing policy to
achieve a 25% reduction in CVD mortality by 2025.
We envision a world free from the burden of preventable
cardiovascular disease (CVD), in which all people from
all backgrounds can access cardiovascular care that is
effective, affordable and safe.
For more information, contact [email protected]
www.worldheart.org
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