AHA doubles down on global support, prevention and research in rheumatic heart disease

A pair of articles appearing in the American Heart Association’s (AHA) journal Circulation lays out a call to action for advocacy and scientific priorities crucial to the global eradication of rheumatic heart disease (RHD).

Cardiologists from Children’s National Hospital, and others who completed their pediatric cardiology fellowships at Children’s National before moving on to careers at other institutions, have been active proponents and advocates for these efforts for many years and led key research and clinical care efforts related to RHD in other countries of the world.

These cardiologists, including the associate chief of cardiology at Children’s National, Craig Sable, M.D., who previously served as chair of the AHA Council on Lifelong Congenital Heart Disease and Heart Health in the Young, also helped lead the creation of these new published statements.

Contemporary diagnosis and management of rheumatic heart disease: Implications for closing the gap

This clinical and research statement “seeks 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.”

Key recommendations and related challenges were mapped out, including:

• The need for echocardiography screening based on World Heart Federation echocardiographic criteria for identifying patients earlier, when prophylaxis is more likely to be effective. However, the authors note that several important questions need to be answered before this can translate into public policy.
• The creation of population-based registries to effectively enable optimal care and secondary penicillin prophylaxis within available resources, though the team acknowledges that 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 used as vital therapeutic adjuncts.
• Multidisciplinary team management of health of women with unoperated and operated rheumatic heart disease before, during and after pregnancy is the best approach, though it is a significant challenge.
• Percutaneous balloon mitral valvuloplasty should be considered for patients with isolated mitral stenosis.
• Timely heart valve surgery, especially valve repair for rheumatic mitral regurgitation, can mitigate the progression to heart failure, disability and death. However, some of these procedures are not available to the vast majority of patients in endemic regions.

The recommendations made in the scientific statement form the foundation for the advocacy companion document.

The AHA’s call to action for reducing the global burden of rheumatic heart disease: a policy statement from the AHA

The advocacy statement outlines five key areas of support:

1. Professional healthcare worker education and training.
2. Technical support for the implementation of evidence-based strategies for rheumatic fever/RHD prevention.
3. Access to essential medications and technologies.
4. Research.
5. Advocacy to increase global awareness, resources and capacity for RHD control.

The authors write, “In bolstering the efforts of the American Heart Association to combat RHD, we hope to inspire others to collaborate, communicate and contribute.”

Speaking of the two statements as a whole, the authors of the scientific statement conclude that, “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.”

Read more about Children’s National Heart Institute’s research, education and clinical care in rheumatic heart disease.

Craig Sable, M.D., Associate Chief of the Division of Cardiology and Director of Echocardiography at Children’s National Health System, is working with hundreds of doctors to create a scalable solution to reduce the global burden of rheumatic heart disease (RHD). Dr. Sable received a lifetime achievement award — the 2018 Cardiovascular Disease in the Young (CVDY) Meritorious Achievement Award — from the American Heart Association for his work in Uganda.