Tertiary prevention and treatment of rheumatic heart disease: a National Heart, Lung, and Blood Institute working group summary

Abstract

Although entirely preventable, rheumatic heart disease (RHD), a disease of poverty and social disadvantage resulting in high morbidity and mortality, remains an ever-present burden in low-income and middle-income countries (LMICs) and rural, remote, marginalised and disenfranchised populations within high-income countries. In late 2021, the National Heart, Lung, and Blood Institute convened a workshop to explore the current state of science, to identify basic science and clinical research priorities to support RHD eradication efforts worldwide. This was done through the inclusion of multidisciplinary global experts, including cardiovascular and non-cardiovascular specialists as well as health policy and health economics experts, many of whom also represented or closely worked with patient-family organisations and local governments. This report summarises findings from one of the four working groups, the Tertiary Prevention Working Group, that was charged with assessing the management of late complications of RHD, including surgical interventions for patients with RHD. Due to the high prevalence of RHD in LMICs, particular emphasis was made on gaining a better understanding of needs in the field from the perspectives of the patient, community, provider, health system and policy-maker. We outline priorities to support the development, and implementation of accessible, affordable and sustainable interventions in low-resource settings to manage RHD and related complications. These priorities and other interventions need to be adapted to and driven by local contexts and integrated into health systems to best meet the needs of local communities.

Prospects for the future: supporting the elimination of rheumatic heart disease – a National Heart, Lung, and Blood Institute Workshop Proceedings

“… 16 Lastly, tertiary care WG members evaluated topics related to the diagnosis and management of complications of RHD including surgery and palliative care, underscoring the importance of multilevel efforts (health system, provider, community) to improve the uptake of available evidence-based interventions while also supporting the development of novel feasible interventions. 14 All WGs emphasised the need to enhance research capacity in LMICs and endemic settings as it relates to basic science, clinical research and implementation science to further support the prevention, diagnosis, treatment and management of RHD.…”

“…During the workshop, each WG presented their findings that are described in further detail within this supplement. [13][14][15][16][17] Multiple breakout sessions were held to develop action plans, allowing all the WGs and participants to reflect on the outputs of the workshop, as well as describe the opportunities that ought to be addressed using fundamental discovery science, clinical research and implementation science to support the elimination of RHD. Unique features from each breakout session are included in table 1.…”