{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T14:40:21Z","timestamp":1791211221758,"version":"4.1.0"},"reference-count":30,"publisher":"BMJ","issue":"23","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2015,10,2]]},"published-print":{"date-parts":[[2015,12,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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\u20132013). 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 396 patients, 43.9% were male with median age 18\u2005years (IQR 10\u201340)). 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\u2030 (95% CI 44.35 to 73.75) and 29.06\u2030 (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&lt;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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Newly diagnosed RHD is associated with poor outcomes, mainly in patients with moderate or severe valve disease and no secondary prophylaxis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heartjnl-2015-308237","type":"journal-article","created":{"date-parts":[[2015,11,4]],"date-time":"2015-11-04T22:44:11Z","timestamp":1446677051000},"page":"1901-1906","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":25,"title":["Newly diagnosed rheumatic heart disease among indigenous populations in the Pacific"],"prefix":"10.1136","volume":"101","author":[{"given":"Mariana","family":"Mirabel","sequence":"first","affiliation":[{"name":"D\u00e9partement de Cardiologie, H\u00f4pital Europ\u00e9en Georges Pompidou, Paris, France"},{"name":"INSERM U970, Paris Cardiovascular Research Centre \u00ad PARCC, Paris, France"},{"name":"Universit\u00e9 Paris Descartes, Sorbonne Paris Cit\u00e9, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muriel","family":"Tafflet","sequence":"additional","affiliation":[{"name":"INSERM U970, Paris Cardiovascular Research Centre \u00ad PARCC, Paris, France"},{"name":"Universit\u00e9 Paris Descartes, Sorbonne Paris Cit\u00e9, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baptiste","family":"No\u00ebl","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Cal\u00e9donie, Noum\u00e9a, New Caledonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Parks","sequence":"additional","affiliation":[{"name":"University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Axler","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Cal\u00e9donie, Noum\u00e9a, New Caledonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques","family":"Robert","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Cal\u00e9donie, Noum\u00e9a, New Caledonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Nadra","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Cal\u00e9donie, Noum\u00e9a, New Caledonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwendolyne","family":"Phelippeau","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Cal\u00e9donie, Noum\u00e9a, New Caledonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elodie","family":"Descloux","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Cal\u00e9donie, Noum\u00e9a, New Caledonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9cile","family":"Cazorla","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Cal\u00e9donie, Noum\u00e9a, New Caledonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Missotte","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centre Hospitalier Territorial de Nouvelle 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Caledonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Jubeau","sequence":"additional","affiliation":[{"name":"D\u00e9partement des Evacuations Sanitaires, Contr\u00f4le M\u00e9dical Unifi\u00e9, CAFAT, Noum\u00e9a, New Caledonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corinne","family":"Braunstein","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Cal\u00e9donie, Noum\u00e9a, New Caledonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Philippe","family":"Empana","sequence":"additional","affiliation":[{"name":"INSERM U970, Paris Cardiovascular Research Centre \u00ad PARCC, Paris, France"},{"name":"Universit\u00e9 Paris Descartes, Sorbonne Paris Cit\u00e9, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eloi","family":"Marijon","sequence":"additional","affiliation":[{"name":"D\u00e9partement de 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