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Natural history, screening, and management of rheumatic heart disease

Bongani Mayosi, MBChB, PhD, FCP(SA)
Section Editor
William H Gaasch, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Rheumatic heart disease (RHD) remains a major cause of cardiovascular disease in developing nations, although the prevalence of RHD has declined sharply in industrialized countries during the last century [1].

This topic will review the epidemiology, natural history, screening, and management of RHD. The epidemiology, pathogenesis, diagnosis, treatment, and prevention of acute rheumatic fever are discussed separately. (See "Acute rheumatic fever: Epidemiology and pathogenesis" and "Acute rheumatic fever: Clinical manifestations and diagnosis" and "Acute rheumatic fever: Treatment and prevention".)


Rheumatic heart disease (RHD) is by far the most important form of acquired heart disease in children and young adults living in developing countries (which are inhabited by 80 percent of the world’s population); RHD accounts for about 15 percent of all patients with heart failure in endemic countries [2,3].

A study of RHD cases estimated that there were globally 33.4 cases of rheumatic heart disease, 10.5 million disability-adjusted life-years due to rheumatic heart disease, and 319,400 deaths due to rheumatic heart disease in 2015 [4]. The global mortality burden of RHD decreased by nearly 50 percent from 1990 to 2015, but the prevalence varied widely among countries and was highest in Oceania, central sub-Saharan Africa, and South Asia. Estimated age-standardized prevalence of rheumatic heart disease in 2015 was 3.4 cases per 100,000 population in nonendemic countries and 444 cases per 100,000 population in endemic countries. Twenty countries with an endemic pattern of rheumatic heart disease had an age-standardized prevalence exceeding 1 percent.

RHD is a disease of poverty [5]. The impact of socioeconomic status is illustrated by a study from Kinshasa where the prevalence based on clinical examination was 22.2 per 1000 among children who lived in slums but only 4 per 1000 among children attending the city schools [6]. The importance of socioeconomic factors is further underscored by the virtual disappearance of RHD in the industrialized countries since the mid-20th century, which started well before the introduction of penicillin. In contrast, RHD is still endemic in Africa, Asia, South America, and developing communities of Australasia [7-9].

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Literature review current through: Oct 2017. | This topic last updated: Aug 25, 2017.
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