{ "release_id": "f6f6f1b6f50379ed", "id": "cardio:bottleneck-rheumatic-heart-disease-burden", "owner": "cardio", "kind": "bottleneck", "slug": "bottleneck-rheumatic-heart-disease-burden", "name": "Rheumatic heart disease burden where prevention and valve surgery are hard to reach", "aliases": [], "atlases": [ "cardio" ], "summary_plain": "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.", "summary_technical": "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.", "editorial_state": "draft", "last_substantive_edit": "2026-10-14", "last_evidence_check": "2026-10-14", "next_review_due": null, "identifiers": [], "navigation": { "cardio": { "system": [ "heart" ], "condition-area": [ "valvular-and-congenital-disease" ] } }, "payload": { "stage": "Prevention, diagnosis and access to valve surgery", "scope": "Countries and communities where rheumatic fever and rheumatic heart disease are common, mainly low- and middle-income countries and marginalized communities (WHO fact sheet).", "severity_rationale": "WHO says a large proportion of people are diagnosed late, when damage to the heart is very severe, and that many endemic countries have little or no access to valve surgery.", "burden_claims": [ "cardio:claim-who-rhd-access-gap" ], "current_efforts": [ "cardio:who" ] }, "content_digest": "449c5f5888bc0a66d82ebc53bb04c8e5869b5829f323466d3da9915b5bd09156", "review": { "content_digest": "449c5f5888bc0a66d82ebc53bb04c8e5869b5829f323466d3da9915b5bd09156", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "claims": [ { "release_id": "f6f6f1b6f50379ed", "id": "cardio:claim-who-rhd-access-gap", "owner": "cardio", "subject_entity_id": "cardio:bottleneck-rheumatic-heart-disease-burden", "category": "burden", "statement": "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.", "context": { "id": "cardio:ctx-who-rhd-endemic-regions", "label": "People at risk of or living with rheumatic fever and rheumatic heart disease, worldwide (WHO fact sheet)", "recipient": "mixed", "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_note": "Rheumatic fever mostly affects children and adolescents; rheumatic heart disease is lasting and affects adults too. The fact sheet gives no age range.", "life_stage_terms": null, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Not applicable (descriptive fact sheet)", "eligibility": { "inclusion": [], "exclusion": [] } }, "evidence_stage": "unknown", "certainty": "not_assessed", "certainty_method": null, "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.", "editorial_state": "draft", "checked_at": "2026-10-14", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Challenges, paragraphs 2 and 3", "applicability_note": "Late diagnosis, little or no access to valve surgery, and shortages of penicillin.", "snapshot": { "id": "cardio:who-rheumatic-heart-disease-2026-10-14", "retrieved_at": "2026-10-14T18:21:55Z", "content_hash": "b20a98a05c89764c1a46b0ca4c3df97c04748c04d25d58891bc6c779c7160704", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "cardio:who-rheumatic-heart-disease", "source_type": "webpage", "title": "Rheumatic heart disease (WHO fact sheet)", "canonical_url": "https://www.who.int/news-room/fact-sheets/detail/rheumatic-heart-disease", "identifiers": [], "publication_date": "2025-01-24", "publisher": "World Health Organization", "edition": "Fact sheet page fetched 2026-10-14. The page is dated 24 January 2025.", "reuse_basis": "The WHO terms of use page (fetched 2026-10-14 as cj-who-terms-of-use.html, hash only) says extracts of the information on the WHO site may be reviewed, reproduced or translated for research or private study, but not for sale or for use with commercial purposes, with an acknowledgement of WHO as the source and its URL, and that other uses need prior written authorization. Short quotations with attribution only, while the atlas remains non-commercial. Hash only; the page is not committed.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "Prevention, paragraphs 1 and 2", "applicability_note": "How the disease is prevented.", "snapshot": { "id": "cardio:who-rheumatic-heart-disease-2026-10-14", "retrieved_at": "2026-10-14T18:21:55Z", "content_hash": "b20a98a05c89764c1a46b0ca4c3df97c04748c04d25d58891bc6c779c7160704", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "cardio:who-rheumatic-heart-disease", "source_type": "webpage", "title": "Rheumatic heart disease (WHO fact sheet)", "canonical_url": "https://www.who.int/news-room/fact-sheets/detail/rheumatic-heart-disease", "identifiers": [], "publication_date": "2025-01-24", "publisher": "World Health Organization", "edition": "Fact sheet page fetched 2026-10-14. The page is dated 24 January 2025.", "reuse_basis": "The WHO terms of use page (fetched 2026-10-14 as cj-who-terms-of-use.html, hash only) says extracts of the information on the WHO site may be reviewed, reproduced or translated for research or private study, but not for sale or for use with commercial purposes, with an acknowledgement of WHO as the source and its URL, and that other uses need prior written authorization. Short quotations with attribution only, while the atlas remains non-commercial. Hash only; the page is not committed.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "Treatment, paragraph 1", "applicability_note": "Severe disease often needs valve surgery.", "snapshot": { "id": "cardio:who-rheumatic-heart-disease-2026-10-14", "retrieved_at": "2026-10-14T18:21:55Z", "content_hash": "b20a98a05c89764c1a46b0ca4c3df97c04748c04d25d58891bc6c779c7160704", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "cardio:who-rheumatic-heart-disease", "source_type": "webpage", "title": "Rheumatic heart disease (WHO fact sheet)", "canonical_url": "https://www.who.int/news-room/fact-sheets/detail/rheumatic-heart-disease", "identifiers": [], "publication_date": "2025-01-24", "publisher": "World Health Organization", "edition": "Fact sheet page fetched 2026-10-14. The page is dated 24 January 2025.", "reuse_basis": "The WHO terms of use page (fetched 2026-10-14 as cj-who-terms-of-use.html, hash only) says extracts of the information on the WHO site may be reviewed, reproduced or translated for research or private study, but not for sale or for use with commercial purposes, with an acknowledgement of WHO as the source and its URL, and that other uses need prior written authorization. Short quotations with attribution only, while the atlas remains non-commercial. Hash only; the page is not committed.", "public_text": "quote" } } ], "review": { "content_digest": "819c3e9f9ca4c211d1162c46cf7476362f1abec55e86d29434bada6c574ba0c2", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/cardio--claim-who-rhd-access-gap.json" } ], "decisions": [], "milestones": [], "relationships": { "outgoing": [ { "predicate": "related_to", "label": "The burden this gap sits in", "clinical_claim_not_fact": false, "family": "navigation", "other_entity_id": "cardio:rheumatic-heart-disease", "other_entity_in_atlas": true, "claim_id": null, "evidence": null, "primary": false, "role": null, "valid_from": null, "valid_to": null }, { "predicate": "part_of", "label": "Files under this front", "clinical_claim_not_fact": false, "family": "navigation", "other_entity_id": "cardio:front-prevention-and-lifestyle", "other_entity_in_atlas": true, "claim_id": null, "evidence": null, "primary": true, "role": null, "valid_from": null, "valid_to": null } ], "incoming": [ { "predicate": "addresses", "label": "Addressed by", "clinical_claim_not_fact": false, "family": "navigation", "other_entity_id": "cardio:who", "other_entity_in_atlas": true, "claim_id": null, "evidence": null, "primary": false, "role": null, "valid_from": null, "valid_to": null } ] }, "page_path": "bottlenecks/bottleneck-rheumatic-heart-disease-burden/", "context_path": "api/v1/context/cardio--bottleneck-rheumatic-heart-disease-burden.md" }