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Background: The East Timor Hearts Fund (ETHF) is a charitable organisation involving Australian cardiologists providing outreach screening and cardiac interventions. Method(s): The ETHF database was sectioned into two-year intervals (2009/10, 2011/12, 2013/14, 2015/16, 2017/18). Patient demographics and clinical outcomes were compared to assess temporal change, with subgroup analysis of adult (>18 years old), paediatric and interventional patients. Result(s): Over 10 years, 2,050 patient encounters have occurred. ETHF reviewed 14 times as many patients in 2017/18 as in 2009/10 (1,119 vs 80 patients). Rheumatic and congenital cardiac disease remain very common (39.1% of adult and 74.2% of paediatric new patients), with 1.4% of new patients exhibiting both pathologies simultaneously. Amongst adult patients, median age and proportion of male patients are rising (p < 0.0001). The number of new patients identified with serious rheumatic or congenital heart disease tripled in 2017/18 compared to 2009/10 (99 vs 34 patients, respectively, p < 0.0001). Paediatric case volume has increased over ten-fold (288 new patients in 2017/18 vs 24 in 2009/10, p < 0.0001), with corresponding increase in proportion of paediatric interventions (59.4% in 2017/18 vs 25.0% in 2009/10, p = 0.027). Patients undergoing intervention (n = 87) have extremely low post-procedural complications and mortality (3.4% and 1.1%, respectively), and 100% of eligible patients attend at least one post-procedure appointment. Conclusion(s): Timorese demand for cardiac services has grown exponentially over the decade, with half ETHF's clinical volume undertaken in the most recent two-year period. Patient demographics are altering over time and an increasing number of interventions are being conducted, with excellent outcomes and patient follow-up.Copyright © 2019

Background: The East Timor Hearts Fund (ETHF) is a charitable organisation involving Australian cardiologists who provide outreach screening in Timor-Leste, and cardiac interventions in Australia/New Zealand. Method(s): The ETHF database was utilised to identify patients with disease warranting surgical or percutaneous intervention. Overall demographics and pre- and post-operative factors were assessed, with sub-group analysis of adult and paediatric patients to identify any differences in care. Result(s): Of 221 patients requiring intervention, 101 patients received intervention. Patients were predominantly young (median age 17.5 years) and female (64.7%), with rheumatic heart disease (63.8%). 24 (33.3%) women aged 15-45yo were documented as pregnant with severe cardiac disease. Of patients not proceeding to intervention, adults were more likely to be lost to follow-up (42.4% vs 18.5%) while paediatric patients were more likely to experience progression of disease (18.5% vs 7.5%, p = 0.005). Median waitlist time was 5 months, with no difference between adults and children, correlating with pre-operative mortality of 5.4%. Post-procedure mortality was extremely low (0.9%) and attendance of at least one post-procedure review excellent (99.0%). 11 (10.9%) patients have required repeat intervention, with no difference in rates between adult and paediatric patients. Conclusion(s): The Timor-Leste interventional cohort are predominantly a young female population with rheumatic and congenital cardiac disease. Delayed access to intervention may result in pre-operative adverse events and mortality, and is a key target for improvement. Patients who undergo surgery have very low post-procedural mortality, excellent adherence to medical follow-up and good long-term outcomes.Copyright © 2019

Background: The East Timor Hearts Fund (ETHF) is a charitable organisation involving Australian cardiologists providing outreach screening and cardiac interventions. Method(s): The ETHF database was sectioned into two-year intervals (2009/10, 2011/12, 2013/14, 2015/16, 2017/18). Patient demographics and clinical outcomes were compared to assess temporal change, with subgroup analysis of adult (>18 years old), paediatric and interventional patients. Result(s): Over 10 years, 2,050 patient encounters have occurred. ETHF reviewed 14 times as many patients in 2017/18 as in 2009/10 (1,119 vs 80 patients). Rheumatic and congenital cardiac disease remain very common (39.1% of adult and 74.2% of paediatric new patients), with 1.4% of new patients exhibiting both pathologies simultaneously. Amongst adult patients, median age and proportion of male patients are rising (p < 0.0001). The number of new patients identified with serious rheumatic or congenital heart disease tripled in 2017/18 compared to 2009/10 (99 vs 34 patients, respectively, p < 0.0001). Paediatric case volume has increased over ten-fold (288 new patients in 2017/18 vs 24 in 2009/10, p < 0.0001), with corresponding increase in proportion of paediatric interventions (59.4% in 2017/18 vs 25.0% in 2009/10, p = 0.027). Patients undergoing intervention (n = 87) have extremely low post-procedural complications and mortality (3.4% and 1.1%, respectively), and 100% of eligible patients attend at least one post-procedure appointment. Conclusion(s): Timorese demand for cardiac services has grown exponentially over the decade, with half ETHF's clinical volume undertaken in the most recent two-year period. Patient demographics are altering over time and an increasing number of interventions are being conducted, with excellent outcomes and patient follow-up.Copyright © 2019

Background: The East Timor Hearts Fund (ETHF) is a charitable organisation involving Australian cardiologists who provide outreach screening in Timor-Leste, and cardiac interventions in Australia/New Zealand. Method(s): The ETHF database was utilised to identify patients with disease warranting surgical or percutaneous intervention. Overall demographics and pre- and post-operative factors were assessed, with sub-group analysis of adult and paediatric patients to identify any differences in care. Result(s): Of 221 patients requiring intervention, 101 patients received intervention. Patients were predominantly young (median age 17.5 years) and female (64.7%), with rheumatic heart disease (63.8%). 24 (33.3%) women aged 15-45yo were documented as pregnant with severe cardiac disease. Of patients not proceeding to intervention, adults were more likely to be lost to follow-up (42.4% vs 18.5%) while paediatric patients were more likely to experience progression of disease (18.5% vs 7.5%, p = 0.005). Median waitlist time was 5 months, with no difference between adults and children, correlating with pre-operative mortality of 5.4%. Post-procedure mortality was extremely low (0.9%) and attendance of at least one post-procedure review excellent (99.0%). 11 (10.9%) patients have required repeat intervention, with no difference in rates between adult and paediatric patients. Conclusion(s): The Timor-Leste interventional cohort are predominantly a young female population with rheumatic and congenital cardiac disease. Delayed access to intervention may result in pre-operative adverse events and mortality, and is a key target for improvement. Patients who undergo surgery have very low post-procedural mortality, excellent adherence to medical follow-up and good long-term outcomes.Copyright © 2019

Introduction: Anecdotal evidence suggests a significant burden of Rheumatic Heart Disease (RHD) in Timor-Leste. We conducted the first echocardiography-based screening study to determine the prevalence of RHD in school-aged Timorese children. Additionally, we prospectively tested the utility of an abbreviated echocardiographic screening protocol limited to the parasternallong- axis-view. Method(s): Students were enrolled from schools in urban and rural districts in Timor-Leste, using opt-out consent that was approved by ethics committees. All students underwent a full screening echocardiogram performed on a Vivid I or Q machine by cardiologists. Following the first parasternal-long-axis-view with 2-D and colour-Doppler, cardiologists were required to log any abnormalities detected prior to proceeding to a full screening study. Those with abnormal screening studies immediately underwent a full congenital echocardiogram. RHD was classified as borderline or definite as per World Heart Federation criteria. The prevalence of RHD and the sensitivity and specificity of the abbreviated protocol was calculated. Result(s): Total of 1413 children were screened; 739 (52%) female and the median age was 12 years (range 4-24). The point prevalence of definite RHD was 1.8% and borderline 1.6% (total 3.4%). An abnormal parasternal-long-axis-view was documented in 113/1413 (8.0%). No cases of RHD were missed. The sensitivity and the specificity of the abbreviated protocol in detecting RHD was 1.0 and 0.95 (CI 95% 0.94-0.96) respectively. Congenital heart disease was identified in 20 children (1.4%) with 2 needing cardiac surgery. Of these 14 had abnormalities on parasternal-long-axis-view. Only insignificant congenital cardiac defects were missed. All children were linked to care. Conclusion(s): This prospective study showed that an abbreviated screening protocol, in school-aged children, limited to a single parasternal-long-axis-view had very high sensitivity and specificity to dete

Introduction: Anecdotal evidence suggests a significant burden of Rheumatic Heart Disease (RHD) in Timor-Leste. We conducted the first echocardiography-based screening study to determine the prevalence of RHD in school-aged Timorese children. Additionally, we prospectively tested the utility of an abbreviated echocardiographic screening protocol limited to the parasternallong- axis-view. Method(s): Students were enrolled from schools in urban and rural districts in Timor-Leste, using opt-out consent that was approved by ethics committees. All students underwent a full screening echocardiogram performed on a Vivid I or Q machine by cardiologists. Following the first parasternal-long-axis-view with 2-D and colour-Doppler, cardiologists were required to log any abnormalities detected prior to proceeding to a full screening study. Those with abnormal screening studies immediately underwent a full congenital echocardiogram. RHD was classified as borderline or definite as per World Heart Federation criteria. The prevalence of RHD and the sensitivity and specificity of the abbreviated protocol was calculated. Result(s): Total of 1413 children were screened; 739 (52%) female and the median age was 12 years (range 4-24). The point prevalence of definite RHD was 1.8% and borderline 1.6% (total 3.4%). An abnormal parasternal-long-axis-view was documented in 113/1413 (8.0%). No cases of RHD were missed. The sensitivity and the specificity of the abbreviated protocol in detecting RHD was 1.0 and 0.95 (CI 95% 0.94-0.96) respectively. Congenital heart disease was identified in 20 children (1.4%) with 2 needing cardiac surgery. Of these 14 had abnormalities on parasternal-long-axis-view. Only insignificant congenital cardiac defects were missed. All children were linked to care. Conclusion(s): This prospective study showed that an abbreviated screening protocol, in school-aged children, limited to a single parasternal-long-axis-view had very high sensitivity and specificity to dete