Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Nov 29;17(1):793.
doi: 10.1186/s12913-017-2747-5.

Rheumatic heart disease: infectious disease origin, chronic care approach

Judith M Katzenellenbogen  1   2 , Anna P Ralph  3   4 , Rosemary Wyber  5 , Jonathan R Carapetis  5   6
Affiliations
Review

Rheumatic heart disease: infectious disease origin, chronic care approach

Judith M Katzenellenbogen et al. BMC Health Serv Res. .

Abstract

Background: Rheumatic heart disease (RHD) is a chronic cardiac condition with an infectious aetiology, causing high disease burden in low-income settings. Affected individuals are young and associated morbidity is high. However, RHD is relatively neglected due to the populations involved and its lower incidence relative to other heart diseases.

Methods and results: In this narrative review, we describe how RHD care can be informed by and integrated with models of care developed for priority non-communicable diseases (coronary heart disease), and high-burden communicable diseases (tuberculosis). Examining the four-level prevention model (primordial through tertiary prevention) suggests primordial and primary prevention of RHD can leverage off existing tuberculosis control efforts, given shared risk factors. Successes in coronary heart disease control provide inspiration for similarly bold initiatives for RHD. Further, we illustrate how the Chronic Care Model (CCM), developed for use in non-communicable diseases, offers a relevant framework to approach RHD care. Systems strengthening through greater integration of services can improve RHD programs.

Conclusion: Strengthening of systems through integration/linkages with other well-performing and resourced services in conjunction with policies to adopt the CCM framework for the secondary and tertiary prevention of RHD in settings with limited resources, has the potential to significantly reduce the burden of RHD globally. More research is required to provide evidence-based recommendations for policy and service design.

Keywords: Acute rheumatic fever; Chronic care; Prevention; Rheumatic heart disease.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Rheumatic heart disease: disease development and progression. Source: Authors’ compilation
Fig. 2
Fig. 2
Comparison of strategies to prevent and control rheumatic heart disease, coronary heart disease and tuberculosis. Source: Authors’ compilation
Fig. 3
Fig. 3
Diagonal approach to harness inputs from vertical programs for rheumatic heart disease: pathway across the life course. Source: Authors’ compilation
Fig. 4
Fig. 4
Application of the Chronic Care Model to an intervention to improve ARF/RHD secondary prophylaxis. Source: Compiled by investigators of the Secondary Prophylaxis Trial, not previously published in this form and approved for publication in this article by investigators, including one of the authors (APR)
See this image and copyright information in PMC

References

    1. Omran AR. The epidemiologic transition. A theory of the epidemiology of population change. Milbank Mem Fund Q. 1971;49(4):509–538. doi: 10.2307/3349375. - DOI - PubMed
    1. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380:2197–2223. doi: 10.1016/S0140-6736(12)61689-4. - DOI - PubMed
    1. Lyons JG, Stewart S. Convergent communicable and noncommunicable heart disease. Nat Rev Cardiol. 2012;9:12–14. doi: 10.1038/nrcardio.2011.180. - DOI - PubMed
    1. Zuhlke L, Engel ME, Karthikeyan G, Rangarajan S, Mackie P, Cupido B, et al. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the global rheumatic heart disease registry (the REMEDY study). Europ Heart J. 2014; doi:10.1093/eurheartj/ehu449. - PMC - PubMed
    1. Carapetis JR. The stark reality of rheumatic heart disease. Eur Heart J. 2015;36(18):1070–1073. doi: 10.1093/eurheartj/ehu507. - DOI - PubMed

LinkOut - more resources