The inaugural international guidelines for the diagnosis of rheumatic heart disease (RHD), a disease that affects tens of millions of people worldwide, have today been published by the World Heart Federation in Nature Reviews Cardiology.
The guidelines define the minimum requirements needed to diagnose RHD in individuals without a clear history of acute rheumatic fever (ARF), and will have important global and national implications.
Diagnosis is conducted with an ultrasound of the heart's valves and chambers, known as an echocardiogram, but currently no guidelines are available to define what is normal on echocardiography.
In the absence of definitive guidance, physicians reporting on echocardiograms make decisions based on their clinical experience, and missing the disease at an early stage can have devastating consequences.
"The new evidence-based guidelines clearly define not only what is considered to be a definite and a borderline case of RHD but also what is considered normal in children," said Dr Bo Reményi, Menzies School of Health Research, Darwin, Australia. "The aim of the guidelines is to maximise pick-up of minor degrees of RHD, while preventing over-diagnosis."
The World Heart Federation echocardiographic criteria for RHD have been developed and formulated on the basis of the best available evidence.
"The use of the guidelines should enable rapid identification of RHD patients who do not have a history of ARF," said Prof Jonathan Carapetis, a co-author of the guidelines and Director of the Menzies School of Health Research in Darwin, Australia.
Dr Nigel Wilson a co-author and Paediatric Cardiologist from the Starship Children's Hospital, Auckland New Zealand commented that "the guidelines should also allow for consistent echocardiographic reporting of RHD worldwide, which will in turn help us to get a better understanding of the number of people that are truly affected by this disease."
Three categories have been defined on the basis of assessment by 2D, continuous-wave, and color-Doppler echocardiography: 'definite RHD', 'borderline RHD', and 'normal'. Four subcategories of 'definite RHD' and three subcategories of 'borderline RHD' exist, to reflect the various disease patterns.
RHD, a chronic heart condition in which the heart valves are damaged, is caused by one or more previous bouts of rheumatic fever that can be prevented and controlled. Rheumatic fever is caused by a preceding group A streptococcal (strep) throat infection. Treating strep throat with antibiotics can prevent rheumatic fever. Moreover, regular antibiotics (usually four-weekly injections) can prevent patients with previous rheumatic fever from contracting further attacks of rheumatic fever and hence progression of valve damage.
RHD is a substantial global health problem that can result in irreversible heart damage and premature death. It occurs predominately in developing countries and is also common in poorer populations in middle-income countries (e.g. Brazil, India) and some indigenous populations in wealthy countries (Australia, New Zealand). RHD will continue to be a global problem unless current prevention initiatives are expanded and sustained.
Previous estimates state that more than 15 million people have RHD and that 350,000 people die each year while many more are left disabled.
Developing the Guidelines
An international advisory group of experts in RHD screening and echocardiographic manifestations of RHD was formed in 2009. Under the auspices of the World Heart Federation, this group of 21 investigators from six continents combined their clinical experience with detailed systematic literature review to developed evidence-based echocardiographic diagnostic guidelines for RHD.
The guideline co-authors include Drs Bo Reményi, Nigel Wilson, Andrew Steer, Beatriz Ferreira, Joseph Kado, Krishna Kumar, John Lawrenson, Graeme Maguire, Eloi Marijon, Mariana Mirabel, Ana Olga Mocumbi, Cleonice Mota, John Paar, Anita Saxena, Janet Scheel, John Stirling, Satupaitea Viali, Vijayalakshmi I. Balekundri, Gavin Wheaton, Liesl Zühlke and Jonathan Carapetis.
About the World Heart Federation
The World Heart Federation is dedicated to leading the global fight against heart disease and stroke with a focus on low- and middle-income countries via a united community of more than 200 member organizations. With its members, the World Heart Federation works to build global commitment to addressing cardiovascular health at the policy level, generates and exchanges ideas, shares best practice, advances scientific knowledge and promotes knowledge transfer to tackle cardiovascular disease – the world's number one killer. It is a growing membership organization that brings together the strength of medical societies and heart foundations from more than 100 countries. Through our collective efforts we can help people all over the world to lead longer and better heart-healthy lives. http://www.worldheart.org.
RHD at the World Congress of Cardiology
RHD will be a major topic at the upcoming World Congress of Cardiology Scientific Sessions (WCC) meeting in Dubai, April 18, 2012. The WCC is the official congress of the World Heart Federation and is held every two years. Through the Congress the World Heart Federation offers an international stage for the latest developments in science and public outreach in the field of cardiovascular health. The WCC places emphasis on the complementary nature of science and public outreach and strives to spread the message that through individual, community and patient-care interventions, the growing epidemic of cardiovascular diseases can be prevented. For more information, please visit http://www.worldcardiocongress.org
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