Estimates of the global burden of rheumatic heart disease.

In this review, we make the case that currently available figures used to define the global burden of acute rheumatic fever and rheumatic heart disease, although crucial to control efforts, are imperfect. Data have been hindered by methodological differences between studies, by patchy coverage within countries and across regions, and by an incomplete understanding of the relationship between echocardiographic detection of asymptomatic mild disease and progression to symptomatic disease. We argue that in order to advocate effectively for patients with rheumatic heart disease now and into the future, true burden of disease estimates on local, national, and international levels are urgently required. We critically review previous burden of disease estimates and outline the issues in defining the "true" burden of rheumatic heart disease, and we propose a new model for rheumatic heart disease epidemiologic studies. This is of particular relevance in 2012 with an ever-increasing burden of cardiovascular disease globally.