1. ©2007 World Heart Federation … Updated October 2008 Diagnosis and Management of Acute Rheumatic Fever and Rheumatic Heart Disease

2. ©2007 World Heart Federation … Updated October 2008 Introduction Acute Rheumatic Fever and Rheumatic Heart Disease

3. ©2007 World Heart Federation … Updated October 2008 This presentation is intended to support the Curriculum for training health workers and others involved in the diagnosis and management of acute rheumatic fever and rheumatic heart disease. It has been made possible thanks to the support of the Vodafone Group Foundation and the International Solidarity, State of Geneva, and the ongoing support of Menzies School of Health Research, Caritas Australia, Fiji Water Foundation, Cure Kids and Accor Hospitality.

4. ©2007 World Heart Federation … Updated October 2008 Introduction Rheumatic Heart Disease is the most common cause of heart disease in children and young adults –Approximately 15.6 million people affected worldwide –Almost 500,000 new cases each year –Approx 350,000 deaths each year –Most disease occurs in developing countries. Rheumatic Heart Disease is a disease of poverty Rheumatic Heart Disease can be prevented.

5. ©2007 World Heart Federation … Updated October 2008 Definitions (GAS) Group A beta-haemolytic streptococci (GAS) –Humans are exposed to GAS in the environment –Throat and skin are common sites of GAS infection –GAS infections usually resolve without treatment –Untreated GAS infections can lead to acute rheumatic fever in some people.

6. ©2007 World Heart Federation … Updated October 2008 Definitions (ARF) Acute Rheumatic Fever (ARF) –A delayed auto-immune response following untreated GAS infection –Develops after the GAS infection has resolved –Commonly affects the joints, heart, central nervous system and skin –Most common between the ages of 5 and 15 years –Can recur following further untreated GAS infections (RHD) Rheumatic Heart Disease (RHD) –Residual damage to heart valves following recurrent ARF –Valves become scarred, stiff, thickened –Blood leaks (blood flows backwards through valves which do not close properly) –Blood is blocked (blood can not flow through valves which do not open properly)

7. ©2007 World Heart Federation … Updated October 2008 Risk Factors Risk factors ARF include –Poverty –Poor housing, overcrowded housing –Lack of adequate health care –Untreated GAS infections Risk factor for RHD –Recurrent ARF Prevention –The first episode of ARF can be prevented by treating GAS infections with penicillin (primary prophylaxis) –If the first ARF episode is not prevented, recurrent ARF can be prevented with long-term penicillin (secondary prophylaxis)

8. ©2007 World Heart Federation … Updated October 2008 Disease Progression

9. ©2007 World Heart Federation … Updated October 2008 Control of Disease ARF and RHD can be prevented by sustainable control strategies including –Trained health staff who diagnose and management disease effectively –Secondary prophylaxis to prevent further ARF and the development or worsening of RHD. –Community education and awareness –Screening for unknown RHD in the community. Control strategies should focus on –Prompt identification and treatment of GAS infections –Identifying people who have had ARF once and preventing further ARF and the development of RHD.