These intervals apply to most patients with each valve lesion and do not take into consideration the etiology of the valve disease. *With normal stroke volume. LV indicates left ventricle; MV, mitral valve; VHD, valvular heart disease; and Vmax , maximum velocity. CLINICAL STATEMENTS AND GUIDELINES isolated muscle training may be used to strengthen in- dividual muscle groups. Most patients with LV systolic dysfunction and severe VHD will undergo intervention for the valve itself. However, if intervention is declined or not feasible, standard GDMT drug therapy for LV sys- tolic dysfunction should be continued, including diuret- ics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta blockers, aldosterone antagonists, and/or sacubitril/valsartan and biventricular pacing, as indicated in the guidelines for heart failure (HF).1 In patients with stenotic valve lesions, abrupt lowering of blood pressure should be avoided.1 Rheumatic fever prophylaxis and infective endocardi- tis (IE) prophylaxis should be provided to appropriate groups of patients, as outlined in Sections 2.4.1 and 2.4.2. The maintenance of optimal oral health remains the most important component of an overall healthcare program in preventing IE. Influenza and pneumococcal vaccinations should follow standard recommendations in patients with VHD. For subsets of patients with AF and VHD, anticoagulation is discussed in Section 2.4.3. 2.4.1. Secondary Prevention of Rheumatic Fever Recommendation for Secondary Prevention of Rheumatic Fever COR LOE Recommendation In patients with rheumatic heart disease, secondary prevention of rheumatic fever is indicated (Tables 6 Synopsis Rheumatic fever is an important cause of VHD world- wide, although it is less common in high-income coun- tries. Rapid detection and treatment of streptococcal pharyngitis constitute primary prevention of rheumatic fever. 