2023 World Heart Federation guidelines for the echocardiographic diagnosis of rheumatic heart disease

• Published in: Nature reviews cardiology 2024-04, Vol.21 (4), p.250-263
• Main Authors: Rwebembera, Joselyn, Marangou, James, Mwita, Julius Chacha, Mocumbi, Ana Olga, Mota, Cleonice, Okello, Emmy, Nascimento, Bruno, Thorup, Lene, Beaton, Andrea, Kado, Joseph, Kaethner, Alexander, Kumar, Raman Krishna, Lawrenson, John, Marijon, Eloi, Mirabel, Mariana, Nunes, Maria Carmo Pereira, Piñeiro, Daniel, Pinto, Fausto, Ralston, Kate, Sable, Craig, Sanyahumbi, Amy, Saxena, Anita, Sliwa, Karen, Steer, Andrew, Viali, Satupaitea, Wheaton, Gavin, Wilson, Nigel, Zühlke, Liesl, Reményi, Bo
• Format: Article
• Language: English
• Subjects: 692/4019/592/75/591; 692/700/1421/1860/1445; Anti-Bacterial Agents - therapeutic use; Cardiac Imaging; Cardiac Surgery; Cardiology; Cardiovascular disease; Child; Echocardiography; Evidence-Based Guidelines; Heart; Humans; Mass Screening; Medicine; Medicine & Public Health; Prevalence; Rheumatic Heart Disease - diagnostic imaging; Rheumatic Heart Disease - epidemiology; Risk Factors; Young Adult
• ISSN: 1759-5002; 1759-5010
• DOI: 10.1038/s41569-023-00940-9

Rheumatic heart disease (RHD) is an important and preventable cause of morbidity and mortality among children and young adults in low-income and middle-income countries, as well as among certain at-risk populations living in high-income countries. The 2012 World Heart Federation echocardiographic criteria provided a standardized approach for the identification of RHD and facilitated an improvement in early case detection. The 2012 criteria were used to define disease burden in numerous epidemiological studies, but researchers and clinicians have since highlighted limitations that have prompted a revision. In this updated version of the guidelines, we incorporate evidence from a scoping review, an expert panel and end-user feedback and present an approach for active case finding for RHD, including the use of screening and confirmatory criteria. These guidelines also introduce a new stage-based classification for RHD to identify the risk of disease progression. They describe the latest evidence and recommendations on population-based echocardiographic active case finding and risk stratification. Secondary antibiotic prophylaxis, echocardiography equipment and task sharing for RHD active case finding are also discussed. These World Heart Federation 2023 guidelines provide a concise and updated resource for clinical and research applications in RHD-endemic regions. A panel of experts from the World Heart Federation provide a revised set of guidelines for the echocardiographic detection of rheumatic heart disease (RHD) in patients living in RHD-endemic regions. The guidelines provide updated screening and confirmatory criteria, as well as a new stage-based classification of RHD based on risk of disease progression, which will improve the diagnosis and subsequent management of patients with RHD.