Aswan Heart Centre Science and Practice Series

CAIRO ACCORD

The Cairo Accord on Rheumatic Heart Disease – 2017

The urgent need for intensifying attempts at eliminating the epidemic of RHD articulated in the Addis Ababa Communique3 and the recommendations issued therein have been endorsed and extended in a recent International conference held in Cairo, called Rheumatic Heart Disease – From Molecules to The Global Community. This meeting was intended to be both comprehensive and unifying; bringing together established and young investigators, international organisations, policymakers, opinion leaders, and NGOs from over 25 countries.

The “Cairo Accord” summarizes the 10 key recommendations of the meeting:

  1. Call for obtaining more accurate data on the epidemiology and natural history of the disease by strengthening the existing databases (e.g., PASCAR e-register), and by ensuring that different databases are capable of cross-communication and data exchange.
  2. Confine the use of echocardiographic screening programmes to research until further evidence regarding its impact on prognosis and cost-effectiveness is made available.
  3. Enhance and coordinate research efforts on the genetics of rheumatogenic streptococcal strains and affected patients. The influence of ethnicity and epigenetics should be included in future studies.
  4. Enhance and coordinate global efforts to produce a vaccine. Strategies to accelerate the production of an effective vaccine (e.g. reverse vaccinology) should be explored and utilized.
  5. Develop biomarkers for early diagnosis and follow up of disease progression.
  6. Provision of high-quality penicillin to affected areas – for both primary and secondary prevention – continues to be an important priority. In parallel, longitudinal studies that provide robust evidence for the benefit of secondary prophylaxis on disease progression should be performed.
  7. Conduct studies that determine the potential value of anti-inflammatory/immunosuppressive therapy after acute rheumatic fever. Other important areas where evidence is needed include optimal stroke prevention strategies in patients with atrial fibrillation and/or mitral stenosis, and pharmacological management of those with heart failure.
  8. Accelerate the development of regional Centres of Excellence equipped with both physical and human resources to deal with prevention and treatment of the disease. Linking these centres into various regional and global research networks will significantly enhance their performance and impact.
  9. Maximize the use of valve repair through educational programmes and exchange of expertise.
  10. Develop tissue-engineered valve substitutes, including percutaneous valves that are both affordable and simple to implant.