Acute rheumatic fever and rheumatic heart disease

Area of Science:

• Cardiovascular Medicine
• Infectious Diseases
• Public Health

Background:

• Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are major causes of preventable cardiovascular mortality and disability, particularly in low- and middle-income countries.
• Group A Streptococcus infection is the underlying cause, with superficial skin infections like impetigo playing a role in ARF pathogenesis.
• Progression from ARF to RHD leads to permanent heart valve damage.

Purpose of the Study:

• To review insights into ARF and RHD pathogenesis, treatment, and control strategies.
• To highlight advancements in early detection, patient care, and therapeutic development.
• To address persistent disparities in care and the need for coordinated global efforts to eliminate RHD.

Main Methods:

• Multidisciplinary and international collaborative research reviews.
• Analysis of clinical trials for novel treatments and delivery mechanisms.
• Examination of revised echocardiographic screening criteria and WHO guidelines.

Main Results:

• New understanding of impetigo's role in ARF and ARF-to-RHD progression.
• Progress in developing Strep A vaccines and novel treatment strategies.
• Advancements in early detection and patient care frameworks, including 2024 WHO guidelines.

Conclusions:

• Despite progress, significant disparities in RHD care, control, and treatment persist, especially in low-resource settings.
• Limited access to cardiac surgery in RHD-burdened countries is a critical issue.
• Future research should focus on implementation studies, translational technologies, and direct patient impact to achieve RHD elimination goals.