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Implementing the World Health Organization Guidelines for Rheumatic Heart Disease in Highly Endemic Settings:

Sulafa K M Ali1

  • 1Department of Clinical Sciences, College of Medicine, University of Sharjah, United Arab Emirates.

Global Heart
|February 23, 2026
PubMed

Insights

Implementing new World Health Organization (WHO) guidelines for rheumatic heart disease (RHD) faces challenges in endemic nations. Simplified diagnostic criteria and accessible echocardiography are key for improving RHD diagnosis and prevention.

Area of Science:

  • Cardiology
  • Public Health
  • Global Health

Background:

  • The 2024 World Health Organization (WHO) guidelines for rheumatic heart disease (RHD) aim to improve management, but implementation in highly endemic regions is difficult.
  • Rheumatic heart disease (RHD) presents severely in endemic areas, requiring pragmatic strategies to enhance diagnostic accuracy and treatment efficacy.
  • Current diagnostic criteria for acute rheumatic fever, like the Jones Criteria, have limitations, potentially missing up to 10% of cases.

Purpose of the Study:

  • To evaluate the challenges and propose pragmatic approaches for implementing the 2024 WHO rheumatic heart disease (RHD) guidelines.
  • To assess the utility of simplified clinical criteria for acute rheumatic fever diagnosis in resource-limited settings.
  • To examine the feasibility of using handheld echocardiography for RHD diagnosis and prevention in endemic countries.

Main Methods:

  • Review of the 2024 WHO RHD guidelines and their recommendations.
  • Analysis of the limitations of existing diagnostic criteria for acute rheumatic fever.
  • Discussion of implementation barriers for handheld echocardiography and benzathine penicillin G in endemic areas.

Main Results:

  • The Jones Criteria for acute rheumatic fever may miss a significant percentage of cases, indicating a need for more sensitive diagnostic tools.
  • Simplified clinical criteria are anticipated to improve diagnostic sensitivity among frontline health workers.
  • Challenges in the availability and training for handheld echocardiography may hinder its widespread adoption for RHD diagnosis and prevention.
  • Availability and administration issues with benzathine penicillin G require resolution for effective RHD treatment.

Conclusions:

  • Adopting simplified clinical criteria can enhance the diagnosis of acute rheumatic fever, especially in resource-limited settings.
  • Overcoming implementation hurdles for handheld echocardiography is crucial for secondary and tertiary RHD prevention.
  • Addressing logistical challenges with benzathine penicillin G is essential for effective rheumatic heart disease management and treatment.

Keywords:
rheumatic heart diseaseworld health organization guidelines

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