Rheumatic Heart Disease in Pregnancy: Global Challenges and Clear Opportunities.

Abstract

Article, see p 806 Rheumatic heart disease (RHD) is a disease of poverty. Following the near eradication of rheumatic fever and RHD in the developed world and the emergence of competing large global epidemics such as AIDS, tuberculosis, and malaria, research and investment for the control of rheumatic fever and RHD worldwide declined.1 However, over the past decade, RHD has reemerged as a priority in global health. The World Health Organization and the World Heart Federation have called for a 25% reduction in mortality because of cardiovascular causes, including RHD, by 2025.2 Contemporary studies have begun to shed light on the enormous burden of RHD that persists in countries with emerging and developing economies. The highest prevalence of RHD has been reported in India, China, Pakistan, Indonesia, and the Democratic Republic of Congo—accounting for 73% of global cases. Within 20 countries where RHD remains endemic, the age-standardized prevalence is estimated at >1% and greatest in women of childbearing age.2 The economic impact of RHD in these regions is equally as unsettling. Disability-adjusted life years because of RHD is estimated at >10 million, accounting for 0.43% of any-cause disability-adjusted life years worldwide.2 In 2015, the first prospective global registry of RHD, from 12 African countries, India, and Yemen, provided a contemporary description of the presentation, complications, and treatment of RHD.2 The lower a country’s income category, the younger the median age and more advanced the disease at presentation.3 This epidemiological pattern has clear and direct implications for the maternal health of a country’s population. The World Health Organization set forth the goal of reducing the global maternal mortality ratio by three quarters between 1990 and 2015. …