Rheumatic Heart Disease: from Molecules to the Global Community - Summary Day 3
Discussions on rheumatic heart disease (RHD) prevention and screening, pathology, and RHD management were the focus on Sunday 15 January, the second full day of ‘Rheumatic Heart Disease: from Molecules to the Global Community’. The meeting – held in Cairo, Egypt – was convened by the Aswan Heart Centre and the Pan-African Society of Cardiology (PASCAR).
Prof. Ganesan Karthikeyan presented an overview of lessons learned from the REMEDY study. He set out some of the critical questions the researchers aimed to investigate, such as who were the patients with RHD in contemporary practice, how did they present with the disease, how was their RHD treated, and were there any differences between endemic regions. Among his team’s findings were that patients in regions where RHD is endemic often presented for care at clinics with advanced disease, and that symptomatic RHD carries a high risk of death at a young age for many patients.
Dr Boglarka Remenyi then addressed some of the achievements and challenges of secondary prevention programs. She drew attention to the importance of tackling RHD using a ‘diagonal approach’, by both tackling RHD directly and simultaneously strengthening health systems and integrating RHD services within primary health care.
One of the highlights of the morning was an interactive debate entitled Echocardiographic Screening for Subclinical RHD: Added Value or Added Cost? Dr Craig Sable spoke in support of subclinical screening, emphasizing the potential cost-effectiveness of such an approach using non-physician health workers. This proposal was opposed by Prof. Ganesan Karthikeyan, who suggested that echo screening should continue to be used as a research tool until sufficient data can be collected to support costly clinical echo screening programmes
The morning session was concluded by the day’s keynote lecture, which was delivered by Prof. Alain Carpentier on The Challenge of Valve Surgery for Advanced Rheumatic Valve Lesions.
Contemporary management of RHD
Professor Peter Zilla – of the University of Cape Town – delivered a presentation entitled ‘Towards developing trans-catheter valves for RHD’, in which he gave an overview of synthetic and automated valves developed at the university. The day then concluded with a presentation by Meeting Director Professor Sir Magdi Yacoub, who spoke on the need to establish cardiac centres of excellence. Placing this need in the context of the AU Communiqué – centres of excellence represent the fifth key action in the declaration – Professor Yacoub provided an overview of the criteria for establishing new centres. In particular he highlighted the importance of these institutions providing health worker training, conducting integrated research, and remaining free to access for all patients.
Looking forward to Day 4
On Monday 16 January – the final day of the conference – the sessions will focus on raising awareness, databases, national programmes and global initiatives.