We strongly object to one point of the comprehensive review by Braun et al. (1): contrary to the statement made by the authors (on page 199 of the article), rheumatic heart disease after recurrent rheumatic fever is certainly the most common cardiac complication in rheumatic diseases worldwide. Reliable sources estimate a prevalence of 33 million cases, of which a significant proportion are children aged 5 to 14 years (2.4 million) (24). About 300 000 new cases, and 233 000 to 294 000 deaths, occur each year due to the disease.

The high levels of morbidity and mortality are certainly due to the fact that many affected persons in less developed and newly industrialized countries have very limited diagnostic and therapeutic options. Access to an often life-saving heart valve surgery is not available to most of these people. However, the indigenous populations in the industrialized countries of Australia (Aboriginal) and New Zealand (Maori) have the highest incidence rates worldwide (3.5 per 1000 inhabitants) (3). These remarks should raise awareness that first, even in wealthy countries, rheumatic heart disease is by no means irrelevant, and second, in Europe (including Germany), the incidence of this disease can be expected to increase due to the immigration of many people from Africa and Asia.

DOI: 10.3238/arztebl.2017.0559a

Dr. med. Carsten Krüger, MIH, FRCPCH

St. Franziskus Hospital

Klinik für Kinder und Jugendliche, Ahlen

thea.carsten.krueger@web.de

Conflict of interest statement

The author declares that no conflict of interest exists.

1.
Braun J, Krüger K, Manger B, Schneider M, Specker C, Trappe HJ: Cardiovascular comorbidity in inflammatory rheumatological conditions. Dtsch Arztebl Int 2017; 114: 197–203 VOLLTEXT
2.
GBD 2013 Mortality and Causes of Death Collaborators: Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 385: 117–71 CrossRef
3.
Carapetis JR, Steer AC, Mulholland EK, Weber M: The global burden of group A streptococcal diseases. Lancet Infect Dis 2005; 5: 685–92 CrossRef
4.
Nulu S, Bukhman G, Kwan GF. Rheumatic heart disease: the unfinished global agenda. Cardiology Clinics 2017; 35: 165–80 CrossRef MEDLINE
1.Braun J, Krüger K, Manger B, Schneider M, Specker C, Trappe HJ: Cardiovascular comorbidity in inflammatory rheumatological conditions. Dtsch Arztebl Int 2017; 114: 197–203 VOLLTEXT
2.GBD 2013 Mortality and Causes of Death Collaborators: Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 385: 117–71 CrossRef
3.Carapetis JR, Steer AC, Mulholland EK, Weber M: The global burden of group A streptococcal diseases. Lancet Infect Dis 2005; 5: 685–92 CrossRef
4.Nulu S, Bukhman G, Kwan GF. Rheumatic heart disease: the unfinished global agenda. Cardiology Clinics 2017; 35: 165–80 CrossRef MEDLINE

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