Abstract
This paper explores the role and place of national, regional, and international society collaborations in addressing the major global burden of rheumatic heart disease (RHD). On the same order of HIV, RHD affects over 40 million people worldwide. In this article, we will outline the background and current therapeutic landscape for cardiac surgery in low- and middle-income countries (LMICs) including the resource-constrained settings within which RHD surgery often occurs. This creates numerous challenges to delivering adequate surgical care and post-operative management for RHD patients, and thus provides some context for a growing movement for and applicability of structural heart approaches, innovative valve replacement technologies, and minimally invasive techniques in this setting. Intertwined and building from this context will be the remainder of the paper which elaborates how national, regional, and international societies have collaborated to address rheumatic heart disease in the past (e.g., Drakensberg Declaration, World Heart Federation Working Group on RHD) with a focus on primary and secondary prevention. We then provide the recent history and context of the growing movement for how surgery has become front and center in the discussion of addressing RHD through the passing of the Cape Town Declaration.
Highlights
Rheumatic heart disease (RHD) affects up to 40 million individuals globally [1]
This was undertaken by two main aims including the formation of an international working group dedicated to this cause and the investment in training of cardiac surgeons and other important staff in low- and middle-income countries (LMICs)
As we look to the future of cardiac surgery for rheumatic heart disease (RHD), it is clear it will continue to require a multisectoral and multidisciplinary effort
Summary
Rheumatic heart disease (RHD) affects up to 40 million individuals globally [1]. Caused by sequalae of skin or throat infection from streptococcal infection, RHD is endemic in low- and middle-income countries, and it is the most common cardiovascular pathology in young individuals aged 25 and younger [2, 3]. Recent global attention has addressed the burden of RHD with commitments to strengthening preventative efforts, as well as surgical efforts, with the adoption of the Drakensberg Declaration in 2006, the World Health Organization Resolution against rheumatic fever (RF) and RHD in 2018 and Cape Town Declaration on Access to Cardiac Surgery in the Developing World in 2018, respectively. These efforts are commendable and will be elaborated upon further in this article. In the context of multisectoral collaboration, we will comment on the need and role of research and the lack of a robust, cardiac surgical registry for RHD patients [10]
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