TY - JOUR
T1 - Contemporary Diagnosis and Management of Rheumatic Heart Disease
T2 - Implications for Closing the Gap A Scientific Statement From the American Heart Association
AU - the American Heart Association Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology
AU - Kumar, Raman Krishna
AU - Antunes, Manuel J.
AU - Beaton, Andrea
AU - Mirabel, Mariana
AU - Nkomo, Vuyisile T.
AU - Okello, Emmy
AU - Regmi, Prakash Raj
AU - Reményi, Boglarka
AU - Sliwa-Hähnle, Karen
AU - Zühlke, Liesl Joanna
AU - Sable, Craig
AU - Ammirati, Enrico
AU - Cunningham, Madeleine W.
AU - Grimaldi, Antonio
AU - Shulman, Stanford T.
AU - Yanagawa, Bobby
N1 - Publisher Copyright:
© 2020 American Heart Association, Inc.
PY - 2020/11/17
Y1 - 2020/11/17
N2 - The global burden of rheumatic heart disease continues to be significant although it is largely limited to poor and marginalized populations. In most endemic regions, affected patients present with heart failure. This statement will seek to examine the current state-of-the-art recommendations and to identify gaps in diagnosis and treatment globally that can inform strategies for reducing disease burden. Echocardiography screening based on World Heart Federation echocardiographic criteria holds promise to identify patients earlier, when prophylaxis is more likely to be effective; however, several important questions need to be answered before this can translate into public policy. Population-based registries effectively enable optimal care and secondary penicillin prophylaxis within available resources. Benzathine penicillin injections remain the cornerstone of secondary prevention. Challenges with penicillin procurement and concern with adverse reactions in patients with advanced disease remain important issues. Heart failure management, prevention, early diagnosis and treatment of endocarditis, oral anticoagulation for atrial fibrillation, and prosthetic valves are vital therapeutic adjuncts. Management of health of women with unoperated and operated rheumatic heart disease before, during, and after pregnancy is a significant challenge that requires a multidisciplinary team effort. Patients with isolated mitral stenosis often benefit from percutaneous balloon mitral valvuloplasty. Timely heart valve surgery can mitigate the progression to heart failure, disability, and death. Valve repair is preferable over replacement for rheumatic mitral regurgitation but is not available to the vast majority of patients in endemic regions. This body of work forms a foundation on which a companion document on advocacy for rheumatic heart disease has been developed. Ultimately, the combination of expanded treatment options, research, and advocacy built on existing knowledge and science provides the best opportunity to address the burden of rheumatic heart disease.
AB - The global burden of rheumatic heart disease continues to be significant although it is largely limited to poor and marginalized populations. In most endemic regions, affected patients present with heart failure. This statement will seek to examine the current state-of-the-art recommendations and to identify gaps in diagnosis and treatment globally that can inform strategies for reducing disease burden. Echocardiography screening based on World Heart Federation echocardiographic criteria holds promise to identify patients earlier, when prophylaxis is more likely to be effective; however, several important questions need to be answered before this can translate into public policy. Population-based registries effectively enable optimal care and secondary penicillin prophylaxis within available resources. Benzathine penicillin injections remain the cornerstone of secondary prevention. Challenges with penicillin procurement and concern with adverse reactions in patients with advanced disease remain important issues. Heart failure management, prevention, early diagnosis and treatment of endocarditis, oral anticoagulation for atrial fibrillation, and prosthetic valves are vital therapeutic adjuncts. Management of health of women with unoperated and operated rheumatic heart disease before, during, and after pregnancy is a significant challenge that requires a multidisciplinary team effort. Patients with isolated mitral stenosis often benefit from percutaneous balloon mitral valvuloplasty. Timely heart valve surgery can mitigate the progression to heart failure, disability, and death. Valve repair is preferable over replacement for rheumatic mitral regurgitation but is not available to the vast majority of patients in endemic regions. This body of work forms a foundation on which a companion document on advocacy for rheumatic heart disease has been developed. Ultimately, the combination of expanded treatment options, research, and advocacy built on existing knowledge and science provides the best opportunity to address the burden of rheumatic heart disease.
KW - AHA Scientific Statements
KW - echocardiography
KW - endocarditis
KW - heart failure
KW - registries
KW - rheumatic heart disease
KW - secondary prevention
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U2 - 10.1161/CIR.0000000000000921
DO - 10.1161/CIR.0000000000000921
M3 - Review article
C2 - 33073615
AN - SCOPUS:85096347412
SN - 0009-7322
VL - 142
SP - E337-E357
JO - Circulation
JF - Circulation
IS - 20
ER -