Fig 3 Flow chart of cohort study, 2008-14. Participants entered the cohort six months after the date of first identification of the presence of a prosthetic valve during the study period to be analysed in a stable condition. At cohort entry, participants had to be aged more than 18 years without a discharge diagnosis code for oral streptococcal infective endocarditis in the previous year or other specific codes related to a prosthetic heart valve during the six months preceding cohort entry