Future priorities
In its 2013 position statement, the World Heart Federation outlined priorities for prevention and control of RHD, aiming to reduce global deaths by 25 per cent by 2015. These include:
1) Register-based control programmes.
2) Global access to penicillin.
3) Support for vaccine research.
4) Establishment of education/training hubs and finding public figures to “champion” RHD prevention.
The prevention of RHD is possible through current methods at a fraction of the cost of treating established disease: globally, implementation of these strategies is patchy and lacks funding. New Zealand is a world leader in the establishment of register-based control programmes, but there is still a need for a national register to maintain contact with often highly mobile poorer families as they move around the country. Nurse-led secondary prophylaxis programmes have demonstrated success, while the targeting of schools in high-risk areas for identification of GAS sore throats has increased early detection rates and access to timely treatment, although the role of screening programmes is subject to debate internationally.