Addressing the challenge of rheumatic heart disease in Pakistan: A call to action

Despite its high prevalence, Acute rheumatic fever (ARF) and Rheumatic heart disease (RHD) is underrepresented in Pakistan's national and federal health plans. To address this gap, we gathered multi-geographic and specialty perspectives from frontline clinicians in Pakistan'. Major challenges in RHD diagnosis and care include regional healthcare disparities, diagnostic limitations, scarcity of Benzathine Penicillin G (BPG) for prophylaxis, and lack of multidisciplinary RHD teams. Our practitioner-informed recommendations emphasize community outreach, targeted screening, and surveillance, and comprehensive training for healthcare providers in the diagnosis and management of GAS infections and ARF. Strengthening multidisciplinary care and ensuring stable BPG supplies are essential, as is integrating RHD care into Universal Health Coverage (UHC) models currently being implemented to reduce patient financial burdens. Improving RHD management requires systemic changes to healthcare infrastructure, practitioner training, and coordinated policy efforts. Crucially, these proposals align with WHO's latest RHD guidelines on primary (treating GAS infections) and secondary prevention (antibiotic prophylaxis and screening). By translating local clinical wisdom into actionable policies, this viewpoint yields practical interventions tailored to Pakistan that are also adaptable to similar LMIC settings.