Rheumatic heart disease (RHD) remains a major preventable cause of cardiovascular morbidity and mortality, particularly in low- and middle-income countries (LMICs) of Asia and Africa. Originating from inadequately treated acute rheumatic fever (ARF) following Group A streptococcal infection, RHD predominantly affects children and young adults and continues to impose a substantial clinical, social, and economic burden. Global Burden of Disease estimates indicate that over 38 million people were affected worldwide in 2017, with hundreds of thousands of deaths annually, disproportionately impacting disadvantaged populations. In India alone, RHD contributes significantly to premature mortality and disability-adjusted life-years lost, with many cases diagnosed at advanced stages requiring costly tertiary care. A major challenge in RHD control is the frequent under-recognition of ARF, with only 30%–50% of cases diagnosed, leading to missed opportunities for early intervention. The disease progresses insidiously to chronic valvular damage, often without a documented history of ARF. Secondary prophylaxis with benzathine penicillin G remains the cornerstone of management but is limited by poor adherence, access barriers, and health system constraints. Echocardiography-based screening, active case detection, and the establishment of RHD registries have shown promise in improving early diagnosis, surveillance, and continuity of care. Community awareness, healthcare worker training, and strengthened national RHD control programs are essential to bridge existing gaps. Closing gaps in awareness, diagnosis, and treatment through integrated prevention strategies, improved access to care, registry-based management, and investment in vaccine research is critical. Coordinated efforts among clinicians, public health systems, researchers, and policymakers are vital to reduce the global burden of this preventable disease and improve long-term outcomes for affected populations.

Keywords: Rheumatic heart disease, cardiovascular morbidity,acute rheumatic fever, Rheumatic heart disease (RHD), acute rheumatic fever (ARF)

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1. Kumar RK, Antunes MJ, Beaton A, Mirabel M, Nkomo VT, Okello E, et al. Contemporary diagnosis and management of rheumatic heart disease: Implications for closing the gap: A scientific statement from the American Heart Association. Circulation. 2020 Nov 17;142(20):e337–e357. doi: 1161/CIR.0000000000000921.
2. Watkins DA, Johnson CO, Colquhoun SM, Karthikeyan G, Beaton A, Bukhman G, et al. Global, regional, and national burden of rheumatic heart disease, 1990–2015. N Engl J Med. 2017 Aug 24;377(8):713–722. doi: 1056/NEJMoa1603693.
3. Kumar R. Rheumatic heart disease: A neglected public health priority. Indian J Public Health. 2019 Jan–Mar;63(1):1–3. doi: 4103/ijph.IJPH_216_18.
4. He VY, Condon JR, Ralph AP, Zhao Y, Roberts K, de Dassel JL, et al. Long-term outcomes from acute rheumatic fever and rheumatic heart disease: A data-linkage and survival analysis approach. Circulation. 2016 Jul 19;134(3):222–232. doi: 1161/CIRCULATIONAHA.115.020966.
5. Cannon J, Roberts K, Milne C, Carapetis JR. Rheumatic heart disease severity, progression and outcomes: A multi-state model. J Am Heart Assoc. 2017 Mar 2;6(3):e003498. doi: 1161 /JAHA .116.003498.
6. Dougherty S, Khorsandi M, Herbst P. Rheumatic heart disease screening: Current concepts and challenges. Ann Pediatr Cardiol. 2017 Jan–Apr;10(1):39–49. doi: 4103/0974-2069.197051.
7. Zühlke L, Engel ME, Karthikeyan G, Rangarajan S, Mackie P, Cupido B, et al. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: The Global Rheumatic Heart Disease Registry (the REMEDY study). Eur Heart J. 2015 May 7;36(18):1115–1122a. doi: 1093/eurheartj/ehu449.
8. Chockalingam A, Gnanavelu G, Elangovan S, Chockalingam V. Clinical spectrum of chronic rheumatic heart disease in India. J Heart Valve Dis. 2003 Sep;12(5):577–581. PMID:14565709.
9. Victor S. Dilemmas in the management of rheumatic heart disease. J Indian Med Assoc. 1999 Jul;97(7):265–270. PMID:10643189.
10. Zhang W, Mondo C, Okello E, Musoke C, Kakande B, Nyakoojo W, et al. Presenting features of newly diagnosed rheumatic heart disease patients in Mulago Hospital: A pilot study. Cardiovasc J 2013 Mar;24(2):28–33. doi: 10.5830/CVJA-2012-076. PMID: 23612950; PMCID: PMC3734881.

Rheumatic heart disease (RHD) remains a major preventable cause of cardiovascular morbidity and mortality, particularly in low- and middle-income countries (LMICs) of Asia and Africa. Originating from inadequately treated acute rheumatic fever (ARF) following Group A streptococcal infection, RHD predominantly affects children and young adults and continues to impose a substantial clinical, social, and economic burden. Global Burden of Disease estimates indicate that over 38 million people were affected worldwide in 2017, with hundreds of thousands of deaths annually, disproportionately impacting disadvantaged populations. In India alone, RHD contributes significantly to premature mortality and disability-adjusted life-years lost, with many cases diagnosed at advanced stages requiring costly tertiary care. A major challenge in RHD control is the frequent under-recognition of ARF, with only 30%–50% of cases diagnosed, leading to missed opportunities for early intervention. The disease progresses insidiously to chronic valvular damage, often without a documented history of ARF. Secondary prophylaxis with benzathine penicillin G remains the cornerstone of management but is limited by poor adherence, access barriers, and health system constraints. Echocardiography-based screening, active case detection, and the establishment of RHD registries have shown promise in improving early diagnosis, surveillance, and continuity of care. Community awareness, healthcare worker training, and strengthened national RHD control programs are essential to bridge existing gaps. Closing gaps in awareness, diagnosis, and treatment through integrated prevention strategies, improved access to care, registry-based management, and investment in vaccine research is critical. Coordinated efforts among clinicians, public health systems, researchers, and policymakers are vital to reduce the global burden of this preventable disease and improve long-term outcomes for affected populations.

Keywords: Rheumatic heart disease, cardiovascular morbidity,acute rheumatic fever, Rheumatic heart disease (RHD), acute rheumatic fever (ARF)

🔒 This is a subscription article

Full text is available to subscribers and institutional members. Please choose an option below to access it.

1. Kumar RK, Antunes MJ, Beaton A, Mirabel M, Nkomo VT, Okello E, et al. Contemporary diagnosis and management of rheumatic heart disease: Implications for closing the gap: A scientific statement from the American Heart Association. Circulation. 2020 Nov 17;142(20):e337–e357. doi: 1161/CIR.0000000000000921.
2. Watkins DA, Johnson CO, Colquhoun SM, Karthikeyan G, Beaton A, Bukhman G, et al. Global, regional, and national burden of rheumatic heart disease, 1990–2015. N Engl J Med. 2017 Aug 24;377(8):713–722. doi: 1056/NEJMoa1603693.
3. Kumar R. Rheumatic heart disease: A neglected public health priority. Indian J Public Health. 2019 Jan–Mar;63(1):1–3. doi: 4103/ijph.IJPH_216_18.
4. He VY, Condon JR, Ralph AP, Zhao Y, Roberts K, de Dassel JL, et al. Long-term outcomes from acute rheumatic fever and rheumatic heart disease: A data-linkage and survival analysis approach. Circulation. 2016 Jul 19;134(3):222–232. doi: 1161/CIRCULATIONAHA.115.020966.
5. Cannon J, Roberts K, Milne C, Carapetis JR. Rheumatic heart disease severity, progression and outcomes: A multi-state model. J Am Heart Assoc. 2017 Mar 2;6(3):e003498. doi: 1161 /JAHA .116.003498.
6. Dougherty S, Khorsandi M, Herbst P. Rheumatic heart disease screening: Current concepts and challenges. Ann Pediatr Cardiol. 2017 Jan–Apr;10(1):39–49. doi: 4103/0974-2069.197051.
7. Zühlke L, Engel ME, Karthikeyan G, Rangarajan S, Mackie P, Cupido B, et al. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: The Global Rheumatic Heart Disease Registry (the REMEDY study). Eur Heart J. 2015 May 7;36(18):1115–1122a. doi: 1093/eurheartj/ehu449.
8. Chockalingam A, Gnanavelu G, Elangovan S, Chockalingam V. Clinical spectrum of chronic rheumatic heart disease in India. J Heart Valve Dis. 2003 Sep;12(5):577–581. PMID:14565709.
9. Victor S. Dilemmas in the management of rheumatic heart disease. J Indian Med Assoc. 1999 Jul;97(7):265–270. PMID:10643189.
10. Zhang W, Mondo C, Okello E, Musoke C, Kakande B, Nyakoojo W, et al. Presenting features of newly diagnosed rheumatic heart disease patients in Mulago Hospital: A pilot study. Cardiovasc J 2013 Mar;24(2):28–33. doi: 10.5830/CVJA-2012-076. PMID: 23612950; PMCID: PMC3734881.