title: Newly diagnosed rheumatic heart disease among indigenous populations in the Pacific.
abstract: OBJECTIVE
  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.
authors.affiliation: Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Mariana
authors.initials: M
authors.lastname: Mirabel
authors.affiliation: INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Tafflet
authors.affiliation: Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia.
authors.forename: Baptiste
authors.initials: B
authors.lastname: Noël
authors.affiliation: University of Oxford, Oxford, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Parks
authors.affiliation: Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia.
authors.forename: Olivier
authors.initials: O
authors.lastname: Axler
authors.affiliation: Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia.
authors.forename: Jacques
authors.initials: J
authors.lastname: Robert
authors.affiliation: Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia.
authors.forename: Marie
authors.initials: M
authors.lastname: Nadra
authors.affiliation: Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia.
authors.forename: Gwendolyne
authors.initials: G
authors.lastname: Phelippeau
authors.affiliation: Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia.
authors.forename: Elodie
authors.initials: E
authors.lastname: Descloux
authors.affiliation: Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia.
authors.forename: Cécile
authors.initials: C
authors.lastname: Cazorla
authors.affiliation: Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Missotte
authors.affiliation: Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia.
authors.forename: Shirley
authors.initials: S
authors.lastname: Gervolino
authors.affiliation: Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia.
authors.forename: Yann
authors.initials: Y
authors.lastname: Barguil
authors.affiliation: Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia.
authors.forename: Bernard
authors.initials: B
authors.lastname: Rouchon
authors.affiliation: Direction des Affaires Sanitaires et Sociales, Nouméa, New Caledonia.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Laumond
authors.affiliation: Département des Evacuations Sanitaires, Contrôle Médical Unifié, CAFAT, Nouméa, New Caledonia.
authors.forename: Thierry
authors.initials: T
authors.lastname: Jubeau
authors.affiliation: Department of Cardiology, Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia.
authors.forename: Corinne
authors.initials: C
authors.lastname: Braunstein
authors.affiliation: INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Empana
authors.affiliation: Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
authors.affiliation: Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Jouven
mesh_terms: D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D015331:Cohort Studies; D003710:Demography; D004452:Echocardiography / Q000379:methods; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D009510:New Caledonia / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D012042:Registries; D012214:Rheumatic Heart Disease / Q000150:complications / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology; D055502:Secondary Prevention / Q000379:methods / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D012959:Socioeconomic Factors