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The percentage of patients with acute carditis of the overall RF patients remained relatively stable.Thirty-two patients (10% of patients with RF) relapsed, including 11 with a cardiac relapse (3.6% of all cardiac patients). The recurrence rate of RF continued to rise up to 9 years from the initial episode. One of 147 patients ( 0.7%) with a non-cardiac initial presentation had carditis at relapse. RF and rheumatic heart disease remain an important cause of morbidity and mortality including developed countries, with relapse rate cont