2023 World Heart Federation guidelines for the echocardiographic diagnosis of rheumatic heart disease

Joselyn Rwebembera, James Marangou, Julius Chacha Mwita, Ana Olga Mocumbi, Cleonice Mota, Emmy Okello, Bruno Nascimento, Lene Thorup, Andrea Beaton, Joseph Kado, Alexander Kaethner, Raman Krishna Kumar, John Lawrenson, Eloi Marijon, Mariana Mirabel, Maria Carmo Pereira Nunes, Daniel Piñeiro, Fausto Pinto, Kate Ralston, Craig SableAmy Sanyahumbi, Anita Saxena, Karen Sliwa, Andrew Steer, Satupaitea Viali, Gavin Wheaton, Nigel Wilson, Liesl Zühlke, Bo Reményi

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)


Rheumatic heart disease (RHD) is an important and preventable cause of morbidity and mortality among children and young adults in low-income and middle-income countries, as well as among certain at-risk populations living in high-income countries. The 2012 World Heart Federation echocardiographic criteria provided a standardized approach for the identification of RHD and facilitated an improvement in early case detection. The 2012 criteria were used to define disease burden in numerous epidemiological studies, but researchers and clinicians have since highlighted limitations that have prompted a revision. In this updated version of the guidelines, we incorporate evidence from a scoping review, an expert panel and end-user feedback and present an approach for active case finding for RHD, including the use of screening and confirmatory criteria. These guidelines also introduce a new stage-based classification for RHD to identify the risk of disease progression. They describe the latest evidence and recommendations on population-based echocardiographic active case finding and risk stratification. Secondary antibiotic prophylaxis, echocardiography equipment and task sharing for RHD active case finding are also discussed. These World Heart Federation 2023 guidelines provide a concise and updated resource for clinical and research applications in RHD-endemic regions.

Original languageEnglish
Pages (from-to)250 - 263
Number of pages14
JournalNature Reviews Cardiology
Issue number4
Early online date2023
Publication statusPublished - Apr 2024

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© Springer Nature Limited 2023.


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