Rheumatic Heart Disease: Understanding, Preventing, and Managing a Preventable Threat
"Exploring the burden of RHD in developing nations and actionable steps for prevention and improved cardiac health."
Rheumatic Heart Disease (RHD) remains a significant cause of cardiovascular problems and deaths, especially in less developed countries. Although its prevalence has decreased in developed nations, RHD continues to affect younger populations in underprivileged regions. The critical aspect of RHD is that it's largely preventable, meaning many complications and deaths can be avoided with the right measures.
RHD results from rheumatic fever, an inflammatory condition triggered by a group A streptococcal infection, commonly known as strep throat. Rheumatic fever primarily impacts the heart, joints, and central nervous system. The most severe consequence is the damage to heart valves, leading to chronic heart disease, heart failure, and, ultimately, death. This condition disproportionately affects children and young adults in low-income countries, contributing to approximately 233,000 deaths each year.
This article explores the findings of a study conducted at the Indira Gandhi Institute of Cardiology, Patna, one of the largest cardiac referral centers in northern India. The study highlights the one-year mortality rate associated with RHD, emphasizing the disease burden in this region and underscoring the importance of preventive strategies. By understanding the scope of the problem and the available interventions, communities and healthcare providers can work together to reduce the impact of this preventable disease.
A Persistent Global Burden
A Global Burden of Diseases, Injuries, and Risk Factors Study 2021 analysis examines rheumatic heart disease (RHD) from 1990 to 2021. RHD follows acute rheumatic fever, which can occur after group A streptococcal infection, and commonly affects the mitral valve. Although prevalence has declined in high-income regions, RHD remains a major burden in low-resource settings and disproportionately affects disadvantaged populations.
Prevention and Clinical Management
Prevention includes educating people about the links between group A Streptococcus infections of the throat or skin and rheumatic fever and RHD, and the importance of appropriate treatment, particularly in moderate- and high-risk settings. Management can involve multidisciplinary care; women with RHD around pregnancy present particular challenges, while patients with isolated mitral stenosis may benefit from percutaneous balloon mitral valvuloplasty. Despite prevention and management advances, the burden remains substantial in low-income countries, and affected patients in endemic regions often present with heart failure.
Unveiling the Study: Mortality and Disease Burden
A retrospective study was conducted, reviewing medical records of patients who died with RHD at the Indira Gandhi Institute of Cardiology, Patna, during 2013. The findings revealed a concerning number of deaths related to RHD. During the study year, the center recorded 120 deaths due to RHD out of a total of 972 deaths. This represents a significant proportion, underscoring the severe impact of RHD on cardiac health in the region.
- Mitral Valve Involvement: Isolated mitral valve affection was the most common valvular lesion, found in approximately 76% of patients.
- Combined Lesions: A combination of mitral and aortic valve lesions was also prevalent, highlighting the complex nature of RHD.
- Severe Valvular Lesions: A significant number of patients (58%) had severe valvular lesions, either single or in combination, emphasizing the advanced stage of the disease at the time of death.
Research on Prevention, Diagnosis, and Awareness
A cross-sectional study in a low-income province of India examined adherence to secondary prophylaxis and awareness of RHD. Its source notes that one study estimated 120 annual RHD deaths at the province’s largest cardiac center, and describes treatment of group A beta-hemolytic streptococcal sore throat as primary prevention. A 2026 Nature Primer by Zühlke and colleagues reviews epidemiology, pathophysiology, diagnosis, management, and quality of life in acute rheumatic fever and RHD.
Preventable Disease, Persistent Deaths
A retrospective study examined medical records of patients who died with RHD in 2013 at the Indira Gandhi Institute of Cardiology in Patna. A separate report describes how repeated rheumatic fever episodes can progressively and permanently damage heart valves, leading to heart failure, arrhythmias, stroke, and early death. It contrasts settings where timely antibiotic treatment has made RHD rare with African communities where children continue to develop and die from it amid limited access to care.
Age of Onset and Unequal Burden
A 2026 review describes RHD as the most common acquired cardiac disease among people under 25 worldwide and, citing Global Burden of Disease 2019 data, places peak incidence at ages 10–19. The World Heart Federation reports that RHD affects 40 million people worldwide and claims more than 300,000 lives each year; it commonly begins in childhood and can cause death or lifelong disability. The burden remains particularly substantial in low-income countries despite advances in prevention and management.
Turning the Tide: Prevention and Future Directions
The data underscores that RHD mortality is a substantial issue in developing regions and emphasizes the critical need for preventive measures. Primary prevention involves treating acute throat infections caused by group A streptococcus with antibiotics, such as penicillin. This simple intervention can prevent the initial attack of rheumatic fever.
Burden and Evidence Gaps
RHD remains a leading cause of acquired cardiac disease in children and a significant health-system burden, especially in low- and middle-income countries. A 2025 global prevalence study notes that acute rheumatic fever occurs at equal prevalence among boys and girls, while focusing on sex differences in RHD. A separate comparative analysis highlights a lack of data about RHD’s impact in the highest-income regions, even though the disease is rare there.
Poverty, Access, and Health-System Inequality
RHD is described as a neglected disease of poverty whose effects reach patients, communities, and health systems, with low-resource countries bearing the highest burden. If untreated, it can damage heart valves and lead to stroke, heart failure, and death. Advanced disease may require costly surgery that is unavailable in many parts of the world, and the persistence of preventable RHD in endemic countries reflects health-system failure and inequality.
Prevention in People’s Lived Contexts
A 2024 case presentation emphasizes that prevention, diagnosis, secondary antibiotic prophylaxis, and management should account for patients’ circumstances, including crowded living conditions and multigenerational housing. It calls for culturally sensitive approaches shaped around those socioeconomic factors. A World Heart Federation report states that RHD affected over 40 million people in 2019 and caused more than 300,000 deaths each year, with a heavy toll on the world’s poorest and most vulnerable communities.
For those who have already experienced rheumatic fever, secondary prevention is crucial to prevent recurrent attacks. Regular administration of antibiotics, typically procaine penicillin, is necessary for many years. Studies suggest that secondary prevention programs are more cost-effective than primary prevention in low to middle-income countries.
To combat RHD effectively, control programs should focus on early diagnosis and ensuring regular secondary prevention. Awareness campaigns, community-level education, and accessible healthcare are vital. Implementing registry systems for acute rheumatic fever and RHD can further strengthen prevention efforts, ultimately reducing the disease burden and saving lives.