{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T16:08:02Z","timestamp":1781626082741,"version":"3.54.5"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"vor","delay-in-days":35,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000862","name":"Sir Halley Stewart Trust","doi-asserted-by":"publisher","award":["Research Grant 2013"],"award-info":[{"award-number":["Research Grant 2013"]}],"id":[{"id":"10.13039\/501100000862","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000862","name":"Sir Halley Stewart Trust","doi-asserted-by":"publisher","award":["Research Grant 2013"],"award-info":[{"award-number":["Research Grant 2013"]}],"id":[{"id":"10.13039\/501100000862","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["222098\/Z\/20\/Z"],"award-info":[{"award-number":["222098\/Z\/20\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["CL-2020-21-001"],"award-info":[{"award-number":["CL-2020-21-001"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Cardiovasc Disord"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Rheumatic heart disease (RHD), a consequence of a dysregulated immune response to\n                      <jats:italic>Streptococcus pyogenes<\/jats:italic>\n                      infection, remains the most commonly acquired cardiovascular condition in under 25-year-olds. Predominantly occurring in low- and middle-income countries (LMICs), RHD has an estimated prevalence of 40.5 million cases globally, although RHD complication rates in endemic settings remain uncertain. Accordingly, we undertook a prospective cohort study of RHD mortality and morbidity in Fiji with the aim of comparing complication rates to those estimated in our previous retrospective studies based on routine data and record-linkage from this setting.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We prospectively ascertained RHD patients in the Central Division of Fiji from: (i) prevalent cases reviewed in echocardiography clinic prior to the study (May 2014-September 2015), and (ii) incident cases diagnosed in hospital (May 2014-October 2016). The primary endpoint comprised the earliest of RHD-attributable death, new onset heart failure or new onset stroke (assessed to October 2016). Differences between groups were assessed using a log-rank test (LRT). Additionally, to further investigate the issue of prevalence-incidence bias, rates of these events in the prospective cohort were also compared to those among patients with similar characteristics from our previously reported retrospective studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During a median of 19.3 months follow-up, the primary endpoint occurred in six out of a total of 163 patients recruited to the study, with an incidence rate of 1.8 (95% CI, 0.6\u20135.5) and 5.3 (95% CI, 1.7\u201316.5) per 100 person-years in the prevalent and incident groups respectively (LRT,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.13). Among 617 comparable individuals from our previous retrospective studies, the primary endpoint occurred in 24 patients with an incidence of 1.4 (95% CI, 0.7\u20132.5) and 6.4 (95% CI, 3.8\u201310.8) per 100 person-years in prevalent and incident groups respectively (LRT,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Complications of RHD were less frequent in the prevalent compared to incident groups, reaching statistical significance in the larger retrospective cohort. Reflecting the impact of systematic differences between the groups, these findings highlight the vulnerability of longitudinal studies of RHD to prevalence-incidence bias, underscoring the need for further robust and representative studies of RHD outcomes in LMICs to inform efforts to limit the impact of RHD globally.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12872-025-05463-4","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T22:05:42Z","timestamp":1766527542000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence-incidence bias in longitudinal studies of rheumatic heart disease in Fiji"],"prefix":"10.1186","volume":"26","author":[{"given":"Tuliana","family":"Cua","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shagorika","family":"Talukder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mai Ling","family":"Perman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Engelman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Steer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Kado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Parks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"key":"5463_CR1","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1056\/NEJMoa1603693","volume":"377","author":"DA Watkins","year":"2017","unstructured":"Watkins DA, Johnson CO, Colquhoun SM, Karthikeyan G, Beaton A, Bukhman G, et al. Global, Regional, and National burden of rheumatic heart Disease, 1990\u20132015. New Engl J Med. 2017;377:713\u201322.","journal-title":"New Engl J Med"},{"key":"5463_CR2","doi-asserted-by":"publisher","first-page":"3338","DOI":"10.1093\/eurheartj\/ehab407","volume":"42","author":"E Marijon","year":"2021","unstructured":"Marijon E, Mocumbi A, Narayanan K, Jouven X, Celermajer DS. Persisting burden and challenges of rheumatic heart disease. Eur Hear J. 2021;42:3338\u201348.","journal-title":"Eur Hear J"},{"key":"5463_CR3","doi-asserted-by":"crossref","unstructured":"Mensah GA, Fuster V, Murray CJL, Roth GA, Global Burden of Cardiovascular Diseases and Risks Collaborators, Mensah GA et al. Global Burden of Cardiovascular Diseases and Risks, 1990\u20132022. J Am Coll Cardiol. 2023;82:2350\u2013473.","DOI":"10.1016\/j.jacc.2023.11.007"},{"key":"5463_CR4","doi-asserted-by":"crossref","unstructured":"Karthikeyan G, Ntsekhe M, Islam S, Rangarajan S, Avezum A, Benz A, et al. 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Cardiovasc J Afr. 2018;29:98\u2013105.","journal-title":"Cardiovasc J Afr"}],"container-title":["BMC Cardiovascular Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12872-025-05463-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-025-05463-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-025-05463-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T15:42:01Z","timestamp":1781624521000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12872-025-05463-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,23]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["5463"],"URL":"https:\/\/doi.org\/10.1186\/s12872-025-05463-4","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-5953030\/v1","asserted-by":"object"}]},"ISSN":["1471-2261"],"issn-type":[{"value":"1471-2261","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,23]]},"assertion":[{"value":"3 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Fiji National Research Ethics Review Committee (FNRERC Number 2013-89) as well as the Oxford University Tropical Research Ethics Committee (1055-13). Consent to participate in the prospective cohort was obtained from all of the participants in the study. The need for consent to participate in the retrospective cohort was waived by the Fiji National Research Ethics Review Committee (FNRERC Number 2013-89).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Consent for publication of data was obtained at the time of recruitment to the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"80"}}