LAUSR

Rheumatic heart disease (RHD) is a preventable condition, yet continues to affect over 30 million people worldwide. The incidence of RHD in high‐income countries (HICs) has declined drastically due to improved sanitation, housing, and access to antibiotics for Group A Streptococcal (GAS) infection. RHD is now perceived as a disease that predominantly affects low‐ to middle‐income countries, but it cannot be forgotten in other settings. Hawkins et al. conducted a retrospective cohort study in the United States and found that the proportion of RHD amongst all mitral valvular diseases was 12.6% and increased by 0.39%/year from 2011 to 2019. Although no differences in operative mortality or morbidity were discerned, patients with RHD required longer hospital and intensive care lengths‐of‐stay. The authors should be congratulated for their compelling study which reminds us that RHD is a disease of inequity and reflects how immigrant, Indigenous, racialized, and low‐ socioeconomic status (SES) populations still face barriers to accessing healthcare. Lack of primary care results in delayed treatment for GAS and acute rheumatic fever and thus a greater likelihood of developing RHD that progresses into mitral valve failure requiring surgical intervention. Subgroup analysis may find the 0.39%/year proportional increase to be especially pronounced in low‐SES communities. Future studies could examine how the prevalence of RHD differs according to immigration rates, household income, and/or demographics. These findings urge researchers, policymakers, and healthcare professionals to consider how social determinants of health and access to care factor into the continued prevalence of RHD in HICs. Heart Team members play an integral role in advocating for patients who cannot obtain timely care for acute rheumatic fever and RHD. Cardiac surgeon‐advocates possess significant social capital that should be used to raise awareness about the consequences of health disparities for patients with RHD. If the moral argument is insufficient in itself, the longer hospital stay associated with RHD is a powerful economic incentive to invest in primary prevention. Hawkins et al.'s study reminds us that RHD will prevail wherever healthcare disparities exist. RHD may be “out of sight, out of mind” in HICs, but it will never be “out of heart” until its underlying social contributors are addressed.