Rheumatic heart disease, or RHD, is a preventable heart condition caused by damage to the heart valves after rheumatic fever.
Rheumatic fever can develop after an untreated or repeated streptococcal throat infection. Over time, repeated inflammation can scar the heart valves, impair heart function, and cause serious long-term complications.
RHD often progresses silently for years before symptoms appear, making early diagnosis, consistent follow-up, and secondary prevention essential.
Rheumatic heart disease is a major cause of cardiovascular disease and premature death worldwide. The burden is highest in communities with limited access to early diagnosis, antibiotics, echocardiography, specialist care, and long-term follow-up.
RHD usually develops through a three-stage pathway.
A common bacterial infection in children, often undertreated in resource-limited settings.
It can cause inflammation in the joints, skin, brain, and heart. When the heart is affected, the inflammation can damage the heart valves.
Repeated episodes of rheumatic fever can cause cumulative scarring of the heart valves. This can lead to valve narrowing or leakage, heart failure, stroke, complications during pregnancy, and the need for advanced cardiac care.
RHD is strongly linked to poverty, overcrowding, and limited access to healthcare. Communities with limited access to primary care, antibiotics, screening, and long-term follow-up face the highest burden.
Children and young adults in low- and middle-income countries are most affected, particularly in sub-Saharan Africa, South Asia, and parts of Oceania. Indigenous communities in high-income countries, including Australia and New Zealand, also experience disproportionately high rates of RHD.
RHD is largely preventable, yet it remains under-recognized as a global health priority. The disease often affects communities with the least access to consistent healthcare, making it both a medical issue and a marker of health inequity.
Preventing RHD requires more than a single treatment. It requires early diagnosis, reliable antibiotics, regular follow-up, patient retention in care, cardiac monitoring, and health systems that can identify people at risk before the disease progresses.
Primary prevention means diagnosing and treating streptococcal throat infections early, usually with antibiotics such as penicillin. This reduces the risk of acute rheumatic fever.
Secondary prevention is for people who have had rheumatic fever or have established RHD. Regular long-acting penicillin injections can stop further episodes of rheumatic fever and reduce further heart valve damage.
For people with advanced RHD, care becomes more specialized. A cardiologist may recommend anticoagulation management or treatment for heart failure, and in some cases, a procedure such as a catheter-based intervention or valve surgery.
People living with RHD often need long-term follow-up, and that follow-up can span clinics, hospitals, and specialist services. Without structured systems in place, patients can fall out of care. They may miss doses of prophylaxis, or face delays before an intervention happens.
Case management tools help clinical teams stay on top of this. Teams can identify patients, track their follow-up, and monitor prevention, while also reviewing outcomes to plan services more effectively. This is where ACT Global's work is focused.
The World Health Organization has recognized registry-based care for rheumatic heart disease as an important non-communicable disease intervention. Structured systems help clinical teams retain patients in care, support regular secondary prevention, review cases consistently, and prioritize advanced care where resources are limited.
ACT Global’s work aligns with this approach by helping local sites use ACT to manage patient follow-up, monitor care gaps, and strengthen data-informed RHD programs.
RHD persists because prevention depends on access to healthcare. Where strep infections go untreated, rheumatic fever is missed, and follow-up care is inconsistent, the cycle of infection and heart valve damage continues.
Heart valve damage caused by RHD cannot usually be reversed. However, further damage can often be prevented with regular secondary prophylaxis, and advanced disease can be managed with specialist care or surgery, where available.
RHD is usually diagnosed with echocardiography, an ultrasound scan of the heart. Echocardiography can detect valve damage before symptoms become severe.
Yes. RHD is largely preventable through prompt treatment of strep throat (and possibly skin infections). For those already diagnosed, monthly antibiotic prophylaxis can slow disease progression and save lives.
Children and young adults in low- and middle-income countries face the highest burden. Indigenous communities in some high-income countries also experience disproportionately high rates.
RHD affects millions worldwide and remains a leading cause of cardiovascular disease in low- and middle-income countries. It claims hundreds of thousands of lives each year, with the greatest burden in low- and middle-income countries.
Data helps health systems know who needs care, who is missing follow-up, where resources are needed, and whether interventions are improving outcomes.
