Global declaration aims to eliminate rheumatic heart disease by 2040

It’s hoped a new international declaration committing to eliminating rheumatic heart disease (RHD) will provide the roadmap to ultimately eradicate the disease not only in Australia but also the rest of the world.

The declaration will be unveiled at the second RHD World Congress in Perth from November 12-14, following from the first RHD World Congress in Abu Dhabi in 2023.

University of WA Professor Jonathan Carapetis is the co-lead of the Strep A translation team at the Kids Research Institute Australia. He said the world is looking to Australia for leadership on how to eradicate this ongoing blight for low to middle income countries and for Aboriginal and Torres Strait Islander people in Australia.

“It has been the most neglected disease globally in terms of the amount of funds that are put into its control and its research compared to how much death and disability it causes,” Professor Carapetis said.

“Australia has led the world both in terms of research in rheumatic heart disease and the bug that causes it, which is called Strep A, but also in terms of raising awareness. But even in our country, whilst we are doing some really good things, we're not doing enough.”

“There's more than 55 million people living with this disease. There's more than 350,000 people who die each year from it, almost all in low middle income countries or in Indigenous populations in high income countries.”

“So populations where there's poverty, poor healthcare systems, there's social injustice, all the sorts of issues that go to the gap that we see in this country between Indigenous and non-Indigenous Australians, that's the same factors, not just in our country, but around the world.”

RHD is entirely preventable yet continues to affect thousands of people across Australia, with almost 12,000 people living with RHD or having a history of acute rheumatic fever (ARF), which causes the condition.

Both RHD and ARF disproportionately affect First Nations peoples, with acute rheumatic fever diagnosed in Aboriginal and Torres Strait Islander people at nearly 20 times the national rate.

“We are still seeing enormous rates of new cases of rheumatic fever occurring and those numbers, they're almost all Indigenous people. We need to recognise that,” he said.

GP awareness of rheumatic heart disease

Professor Carapetis stressed that GPs in Australia are an important part of the solution to eliminating RHD — with building awareness of rheumatic fever symptoms and diagnosis among city-trained doctors identified as a crucial factor.

“GPs need to be aware of rheumatic fever, rheumatic heart disease, and the underlying Strep infections. That's actually one of the first major things that's already coming out in our consultations because a lot of the people who end up servicing remote rural communities are trained in major cities, they're not really aware of this disease,” he said.

“Rheumatic fever is not exclusive to Indigenous people and not exclusive to remote rural areas. So any GP might have someone coming in with rheumatic fever tomorrow, and they certainly will have lots of people with Strep infections. So they need to familiarise themselves.”

Another factor identified in the Medical Journal of Australia in February 2025 is the ongoing shortage of the most effective treatment for RHD, the long-acting penicillin Benzathine benzylpenicillin G (BPG). Advances in understanding rheumatic fever and improved clinical insights are bringing us closer to a diagnostic test for rheumatic fever and to more targeted treatments, as part of an effective national rheumatic fever strategy.

Protecting the most vulnerable populations

RHD is the most common acquired heart disease in people under 25 years old. The highest rates are among First Nations children between 5-14 years old, particularly those living in regional and remote communities. 

“This disease begins in primary school age — that’s when most people get their first case of rheumatic fever. It can come back again during those primary school and early teenage years,” he said.

"And so by the time people are adolescents, if they make it that far, that's when rheumatic heart disease really peaks in adolescents and those young adults.”

“The other thing I think is really important and it's enshrined in this Perth Declaration is we need to prioritise women and girls because a lot of the healthcare systems tend to overlook women and girls, and we know that this is a disease that does have higher rates in women and girls than in boys and men. So we want to make sure that as we elevate the focus on rheumatic heart disease, we're focusing on the people who most need our attention.”

Towards eradication of rheumatic heart disease

The Heart Foundation of Australia is hosting the RHD World Congress to bring together researchers, clinicians, practitioners and people with lived experience from around the world, and unite efforts to end the global burden of the disease.

Heart Foundation Chief Scientific and Medical Officer Professor Derek Chew said RHD is an international equity issue.

“The opportunity now is not only to bring the world's researchers and public health interested parties together to talk about the road forward, but in fact to make a clear declaration of where the world from a global perspective and also from a local perspective needs to continue to drive to eradicate rheumatic heart disease,” Professor Chew said.

Professor Chew said the declaration commits signatories to measurable targets, with the ultimate aim to eliminate RHD as a public threat by 2040.

“This is more than just hopeful. This actually defines a roadmap to that set of goals,” he said.

Declaration goals include investment in healthy housing, water and sanitation to reduce the impact of overcrowding, access to washing facilities and place-based prevention, access to culturally safe healthcare and community led solutions, and antibiotic programs to treat and prevent streptococcal infections.

Professor Carapetis said it’s a relief to see that “after several decades of hard work, finally people are paying attention to this disease.”

“We can eliminate this disease as a priority, which would be incredible if you can imagine how we can say — we can consign a disease like this to the history books,” Professor Carapetis said.

“That would be something we could all be immensely proud of as well as obviously leading to alleviation of death and suffering.”