Policy prioritisation to address the global burden of rheumatic heart disease

Abstract

6 billion people do not have access to safe, timely, and affordable cardiac surgical care when needed, although cardiovascular disease remains the leading cause of morbidity and mortality worldwide.1Vervoort D Swain JD Pezzella AT Kpodonu J Cardiac surgery in low- and middle-income countries: a state-of-the-art review.Ann Thorac Surg. 2021; 111: 1394-1400Summary Full Text Full Text PDF PubMed Scopus (19) Google Scholar Meeting the unmet cardiovascular needs of the world's population requires upscaling existing primary, secondary, and tertiary care capacity, and reducing the current burden of cardiovascular disease. In their modelling study, Matthew Coates and colleagues (July, 2021)2Coates MM Sliwa K Watkins DA et al.An investment case for the prevention and management of rheumatic heart disease in the African Union 2021–30: a modelling study.Lancet Glob Health. 2021; 9: e957-e966Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar illustrate the crucial importance thereof by making an investment case for addressing the burden of rheumatic heart disease, which continues to affect more than 30 million people worldwide, in the African Union (AU). Specifically, they identified a net benefit of US$2·8 billion for the AU through 2030 if secondary prevention and secondary and tertiary care interventions for rheumatic heart disease were scaled up. Despite the 2018 adoption of the World Health Assembly resolution 71.14 on rheumatic fever and rheumatic heart disease, political commitment to addressing rheumatic heart disease and improving broader cardiovascular care worldwide has remained limited.1Vervoort D Swain JD Pezzella AT Kpodonu J Cardiac surgery in low- and middle-income countries: a state-of-the-art review.Ann Thorac Surg. 2021; 111: 1394-1400Summary Full Text Full Text PDF PubMed Scopus (19) Google Scholar Since 2015, National Surgical, Obstetric, and Anesthesia Plans (NSOAPs) have arisen as strategic, long-term plans embedded within national health plans to strengthen health systems in low-income and middle-income countries for improved delivery of surgical, obstetric, and anaesthesia care.3Vervoort D National Surgical, Obstetric, and Anesthesia Plans: bridging the cardiac surgery gap.Thorac Cardiovasc Surg. 2021; 69: 10-12Crossref PubMed Scopus (4) Google Scholar Despite the growing adoption—with six African countries launching their NSOAPs to date and dozens of countries in the process of developing their own—and support of NSOAPs by WHO and the UN, cardiovascular care is almost consistently overlooked,3Vervoort D National Surgical, Obstetric, and Anesthesia Plans: bridging the cardiac surgery gap.Thorac Cardiovasc Surg. 2021; 69: 10-12Crossref PubMed Scopus (4) Google Scholar even though building cardiovascular care capacity will have substantial spillover effects on other surgical and non-surgical health services.4Vervoort D Edwin F Treating pediatric and congenital heart disease abroad? Imperatives for local health system development.Int J Cardiol Congenit Heart Dis. 2021; 2: 1-3Google Scholar In their linked Comment on Coates and colleagues’ study, Emmy Okello and Andrea Beaton eloquently state that “scaling up tertiary services in the AU is also achievable, but will require multisector investment”.5Okello E Beaton A Targeted investment needed to end rheumatic heart disease in Africa.Lancet Glob Health. 2021; 9: e887-e888Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar Findings indeed suggest that the governments of low-income and middle-income countries can save millions of dollars each year while strengthening local health systems if they invest in domestic services for cardiac surgery rather than send patients abroad for care.4Vervoort D Edwin F Treating pediatric and congenital heart disease abroad? Imperatives for local health system development.Int J Cardiol Congenit Heart Dis. 2021; 2: 1-3Google Scholar However, for that to happen, political commitment, increased understanding, and funding availability are needed. More effective integration of cardiovascular care within the growing movement of NSOAP development across sub-Saharan Africa and low-income and middle-income countries worldwide is, therefore, crucial. The investment case by Coates and colleagues2Coates MM Sliwa K Watkins DA et al.An investment case for the prevention and management of rheumatic heart disease in the African Union 2021–30: a modelling study.Lancet Glob Health. 2021; 9: e957-e966Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar is also key in convincing policy makers and funders alike that comprehensive cardiac care is not only morally necessary, but indispensable to promoting socioeconomic growth and fulfilling the UN's Sustainable Development Goals. We declare no competing interests.

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