PT  - JOURNAL ARTICLE
AU  - Mariana Mirabel
AU  - Muriel Tafflet
AU  - Baptiste Noël
AU  - Tom Parks
AU  - Olivier Axler
AU  - Jacques Robert
AU  - Marie Nadra
AU  - Gwendolyne Phelippeau
AU  - Elodie Descloux
AU  - Cécile Cazorla
AU  - Isabelle Missotte
AU  - Shirley Gervolino
AU  - Yann Barguil
AU  - Bernard Rouchon
AU  - Sylvie Laumond
AU  - Thierry Jubeau
AU  - Corinne Braunstein
AU  - Jean-Philippe Empana
AU  - Eloi Marijon
AU  - Xavier Jouven
TI  - Newly diagnosed rheumatic heart disease among indigenous populations in the Pacific
AID  - 10.1136/heartjnl-2015-308237
DP  - 2015 Dec 01
TA  - Heart
PG  - 1901--1906
VI  - 101
IP  - 23
4099  - http://heart.bmj.com/content/101/23/1901.short
4100  - http://heart.bmj.com/content/101/23/1901.full
SO  - Heart2015 Dec 01; 101
AB  - Objectives Rheumatic heart disease (RHD) remains the leading acquired heart disease in the young worldwide. We aimed at assessing outcomes and influencing factors in the contemporary era.Methods Hospital-based cohort in a high-income island nation where RHD remains endemic and the population is captive. All patients admitted with newly diagnosed RHD according to World Heart Federation echocardiographic criteria were enrolled (2005–2013). The incidence of major cardiovascular events (MACEs) including heart failure, peripheral embolism, stroke, heart valve intervention and cardiovascular death was calculated, and their determinants identified.Results Of the 396 patients, 43.9% were male with median age 18 years (IQR 10–40)). 127 (32.1%) patients presented with mild, 131 (33.1%) with moderate and 138 (34.8%) with severe heart valve disease. 205 (51.8%) had features of acute rheumatic fever. 106 (26.8%) presented with at least one MACE. Among the remaining 290 patients, after a median follow-up period of 4.08 (95% CI 1.84 to 6.84) years, 7 patients (2.4%) died and 62 (21.4%) had a first MACE. The annual incidence of first MACE and of heart failure were 59.05‰ (95% CI 44.35 to 73.75) and 29.06‰ (95% CI 19.29 to 38.82), respectively. The severity of RHD at diagnosis (moderate vs mild HR 3.39 (0.95 to 12.12); severe vs mild RHD HR 10.81 (3.11 to 37.62), p<0.001) and ongoing secondary prophylaxis at follow-up (HR 0.27 (0.12 to 0.63), p=0.01) were the two most influential factors associated with MACE.Conclusions Newly diagnosed RHD is associated with poor outcomes, mainly in patients with moderate or severe valve disease and no secondary prophylaxis.