Rheumatic heart disease control: the time for a paradigm shift.

Area of Science:

• Cardiology
• Infectious Diseases
• Public Health

Background:

• Rheumatic heart disease (RHD) is a severe complication of streptococcal pharyngitis, primarily affecting children in low-resource settings.
• Current control methods are hindered by challenges in early diagnosis of pharyngitis and acute rheumatic fever (ARF), often resulting in late-stage, incurable RHD.
• RHD is the leading cause of acquired heart disease in young people globally.

Purpose of the Study:

• To highlight the effectiveness of echocardiography in identifying early-stage RHD in asymptomatic children.
• To advocate for the implementation of a "screen-to-treat" policy using echocardiography for RHD control.
• To emphasize the role of benzathine penicillin in preventing RHD progression.

Main Methods:

• Review of recent evidence on echocardiography screening for latent RHD.
• Analysis of the efficacy of benzathine penicillin prophylaxis in halting RHD progression.
• Assessment of current diagnostic thresholds for streptococcal infection and ARF.

Main Results:

• Echocardiography screening effectively detects 'latent' RHD in asymptomatic children.
• Benzathine penicillin prophylaxis has demonstrated success in halting the progression of latent RHD.
• Lower diagnostic thresholds for streptococcal infection and ARF are recommended.

Conclusions:

• An echocardiography screen-to-treat strategy is warranted for RHD control in endemic areas.
• Early detection and prompt treatment are crucial for managing RHD and preventing its progression.
• Integrating echocardiography into RHD control programs can significantly improve outcomes.