{
  "release_id": "f6f6f1b6f50379ed",
  "id": "cardio:rheumatic-heart-disease",
  "owner": "cardio",
  "kind": "condition",
  "slug": "rheumatic-heart-disease",
  "name": "Rheumatic heart disease",
  "aliases": [
    "RHD",
    "Rheumatic fever and rheumatic heart disease"
  ],
  "atlases": [
    "cardio"
  ],
  "summary_plain": "Rheumatic heart disease is lasting damage to the heart valves after rheumatic fever. Rheumatic fever can follow a sore throat or skin infection caused by group A streptococcus bacteria. The WHO says rheumatic fever mostly affects children and adolescents in low- and middle-income countries and in marginalized communities. The valve damage is permanent, and severe cases often need surgery to repair or replace valves. Treating strep throat with antibiotics prevents rheumatic fever, and after rheumatic fever, antibiotic injections over many years prevent further infections.",
  "summary_technical": "WHO fact sheet on rheumatic heart disease (24 January 2025), MeSH D012214. The fact sheet gives WHO estimates of 55 million people affected and about 360 000 deaths each year, and cites no source for them in the text read. It names World Health Assembly resolution WHA 71.14 (2018) and WHO guidelines on the prevention and diagnosis of rheumatic fever and rheumatic heart disease (2024); the guideline itself is not recorded here. The fact sheet also describes pregnant women with the disease; that maternal context is not recorded in this atlas record. MedlinePlus lists untreated strep throat that becomes rheumatic fever as a way valves are harmed.",
  "editorial_state": "draft",
  "last_substantive_edit": "2026-10-14",
  "last_evidence_check": "2026-10-14",
  "next_review_due": null,
  "identifiers": [
    {
      "scheme": "mesh",
      "value": "D012214",
      "normalized_value": "D012214",
      "match": "exact",
      "version": "linked-data record read 2026-10-14",
      "label": null,
      "from_source": false
    }
  ],
  "navigation": {
    "cardio": {
      "system": [
        "heart"
      ],
      "condition-area": [
        "valvular-and-congenital-disease"
      ]
    }
  },
  "payload": {
    "recognition": "The WHO fact sheet lists symptoms of rheumatic fever and of valve damage, and says a large proportion of people with the disease are diagnosed late.",
    "assessment": null,
    "burden_claims": [
      "cardio:claim-who-rhd-prevalence"
    ]
  },
  "content_digest": "f864d53a55b2de566ecd49c5ee1d9d199246b22fe97dc9c81c39183cdcba3664",
  "review": {
    "content_digest": "f864d53a55b2de566ecd49c5ee1d9d199246b22fe97dc9c81c39183cdcba3664",
    "current": [],
    "conflicting": [],
    "stale": [],
    "inactive": []
  },
  "claims": [
    {
      "release_id": "f6f6f1b6f50379ed",
      "id": "cardio:claim-who-rhd-prevalence",
      "owner": "cardio",
      "subject_entity_id": "cardio:rheumatic-heart-disease",
      "category": "burden",
      "statement": "The WHO fact sheet on rheumatic heart disease says the disease remains prevalent in sub-Saharan Africa, the Middle East, central and south Asia and the south Pacific, and among immigrants and older adults in high-income countries, especially Indigenous peoples. It says rheumatic fever mostly affects children and adolescents in low- and middle-income countries and in marginalized communities. The valve damage is permanent and there is no cure. WHO estimates that the disease affects 55 million people worldwide and claims approximately 360 000 lives each year, the large majority in low- or middle-income countries, and calls it the most commonly acquired heart disease in people under age 25.",
      "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. The figures are WHO estimates, and the text read cites no source for them. The fact sheet also describes pregnant women with the disease; that maternal context is not part of this claim.",
      "editorial_state": "draft",
      "checked_at": "2026-10-14",
      "next_review_due": null,
      "valid_from": null,
      "valid_to": null,
      "citations": [
        {
          "evidence_role": "supports",
          "locator": "Risk factors, paragraphs 1 and 3",
          "applicability_note": "Where the disease is found and whom it affects.",
          "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": "Key facts, bullets 1 and 2",
          "applicability_note": "WHO estimates of people affected and lives lost each year, and the age group.",
          "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": "No cure; the valve damage is permanent.",
          "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": "b7ad24b0080db35f4186438cfb18294d50b75fd98225ea4d083f95b653766959",
        "current": [],
        "conflicting": [],
        "stale": [],
        "inactive": []
      },
      "api_path": "api/v1/claims/cardio--claim-who-rhd-prevalence.json"
    }
  ],
  "decisions": [],
  "milestones": [],
  "relationships": {
    "outgoing": [
      {
        "predicate": "related_to",
        "label": "A cause of valve disease",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "cardio:heart-valve-disease",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "related_to",
        "label": "WHO fact sheet and programme",
        "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
      },
      {
        "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": "related_to",
        "label": "Related to",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "core:medlineplus",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "related_to",
        "label": "Related to",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "cardio:bottleneck-rheumatic-heart-disease-burden",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      }
    ]
  },
  "page_path": "conditions/rheumatic-heart-disease/",
  "context_path": "api/v1/context/cardio--rheumatic-heart-disease.md"
}