# Rheumatic heart disease burden where prevention and valve surgery are hard to reach Bottleneck · id `cardio:bottleneck-rheumatic-heart-disease-burden` · Cardiovascular Atlas · release `f6f6f1b6f50379ed` (public) > General information from published sources, not medical advice, and not reviewed by clinicians. Check the cited source before relying on anything here. The atlas's own text and curation may be reused under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0, https://creativecommons.org/licenses/by-nc/4.0/): credit the atlas, and do not use it commercially. See the atlas About page. Text quoted from a source stays under that source's own terms, given as the source's reuse\_basis. The atlas's reuse terms do not cover it. The downloads list each quotation with its source in third\_party\_quotations. Browse, organ or system: Heart Browse, condition area: Valve and congenital heart disease ## In plain language In many places where rheumatic heart disease is common, WHO says treatment of strep throat at an early stage is often not achieved, and many people are diagnosed late. In many of these countries there is little or no access to valve surgery. The WHO fact sheet names preventing rheumatic fever and a steady supply of penicillin as important strategies. ## Technical summary A prevention and access gap described in the WHO fact sheet: late diagnosis, limited access to life-saving heart valve surgery in endemic countries, and global shortages of benzathine penicillin G. The fact sheet names WHO responses: World Health Assembly resolution WHA 71.14 (2018) and WHO guidelines on prevention and diagnosis (2024). The valve devices recorded elsewhere in this atlas are not tested for this setting in any source read here. ## Claims, with the population each applies to ## Context: People at risk of or living with rheumatic fever and rheumatic heart disease, worldwide (WHO fact sheet) Recipient: Mixed recipients; Population: People at risk of rheumatic fever and living with rheumatic heart disease. WHO says rheumatic fever mostly affects children and adolescents in low- and middle-income countries and in marginalized communities, including Indigenous populations, and that the disease also remains in immigrants and older adults in high-income countries.; Care setting: Health systems in endemic countries, where WHO describes limited access to diagnosis, antibiotics and valve surgery; Geography: Global; the fact sheet names sub-Saharan Africa, the Middle East, central and south Asia, the south Pacific, and immigrants and older adults in high-income countries; Life stage: Rheumatic fever mostly affects children and adolescents; rheumatic heart disease is lasting and affects adults too. The fact sheet gives no age range.; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (descriptive fact sheet) ### The WHO fact sheet says a large proportion of people with rheumatic heart disease are not diagnosed, or are diagnosed at a late stage when damage to the heart is very severe. It says that in many endemic countries there is little or no access to life-saving heart valve surgery, and that severe disease will often require surgery to replace or repair the damaged valves. Prevention rests on treating strep throat with antibiotics and, after rheumatic fever, on benzathine penicillin G injections every 3 to 4 weeks over many years; WHO says that antibiotic is prone to global shortages. - Category: Burden - Evidence stage: Evidence stage unknown - Certainty: Certainty not assessed - Applies to: Recipient: Mixed recipients; Population: People at risk of rheumatic fever and living with rheumatic heart disease. WHO says rheumatic fever mostly affects children and adolescents in low- and middle-income countries and in marginalized communities, including Indigenous populations, and that the disease also remains in immigrants and older adults in high-income countries.; Care setting: Health systems in endemic countries, where WHO describes limited access to diagnosis, antibiotics and valve surgery; Geography: Global; the fact sheet names sub-Saharan Africa, the Middle East, central and south Asia, the south Pacific, and immigrants and older adults in high-income countries; Life stage: Rheumatic fever mostly affects children and adolescents; rheumatic heart disease is lasting and affects adults too. The fact sheet gives no age range.; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (descriptive fact sheet) - Limitations: A descriptive fact sheet. It gives no figure for how many people are diagnosed late or lack access to valve surgery, and cites no studies in the text read, so the size of the gap is not stated. It describes the situation in endemic countries as a group, not any one country. - Last checked: 2026-10-14 - Sources: 1. Supports: Rheumatic heart disease (WHO fact sheet) (Webpage, edition Fact sheet page fetched 2026-10-14. The page is dated 24 January 2025.) Locator: Challenges, paragraphs 2 and 3. Retrieved 2026-10-14T18:21:55Z. Source state: Current. Snapshot hash: b20a98a05c89764c1a46b0ca4c3df97c04748c04d25d58891bc6c779c7160704. How it applies: Late diagnosis, little or no access to valve surgery, and shortages of penicillin. 2. Supports: Rheumatic heart disease (WHO fact sheet) (Webpage, edition Fact sheet page fetched 2026-10-14. The page is dated 24 January 2025.) Locator: Prevention, paragraphs 1 and 2. Retrieved 2026-10-14T18:21:55Z. Source state: Current. Snapshot hash: b20a98a05c89764c1a46b0ca4c3df97c04748c04d25d58891bc6c779c7160704. How it applies: How the disease is prevented. 3. Supports: Rheumatic heart disease (WHO fact sheet) (Webpage, edition Fact sheet page fetched 2026-10-14. The page is dated 24 January 2025.) Locator: Treatment, paragraph 1. Retrieved 2026-10-14T18:21:55Z. Source state: Current. Snapshot hash: b20a98a05c89764c1a46b0ca4c3df97c04748c04d25d58891bc6c779c7160704. How it applies: Severe disease often needs valve surgery. ## Connected pages - The burden this gap sits in: Rheumatic heart disease (`cardio:rheumatic-heart-disease`) - Files under this front: Prevention and lifestyle (`cardio:front-prevention-and-lifestyle`) - Addressed by: World Health Organization (`cardio:who`) ## Provenance Content hash: 449c5f5888bc0a66d82ebc53bb04c8e5869b5829f323466d3da9915b5bd09156 Last substantive edit: 2026-10-14 Evidence last checked: 2026-10-14