The Changing Course of Aortic Valve Disease in Scotland: Temporal Trends in Hospitalizations and Mortality and Prognostic Importance of Aortic Stenosis

Eur Heart J. 2013 Jun;34(21):1538-47. doi: 10.1093/eurheartj/ehs339. Epub 2012 Oct 30.

Abstract

Aims: To investigate the contemporary clinical course of aortic valve disease types.

Methods and results: We performed a retrospective population-level epidemiological study of hospitalized care in Scotland from 1 January 1997 to 31 December 2005 using electronic case identification of hospital admissions and deaths. Time-to-event analyses were performed using Cox Proportional-Hazards models. A total of 19 733 adults with an index hospitalization and a final diagnosis of non-congenital aortic valve disease were identified. Aortic stenosis, aortic insufficiency, mixed aortic valve disease, or unspecified aortic valve disease occurred in 13 220 (67.0%), 2807 (14.2%), 699 (3.5%), and 3007 (15.2%), individuals, respectively. The majority of hospitalizations occurred in elderly persons aged 80 and older. In total, 9981 (50.6%) patients had died by 31 December 2006. When compared with aortic stenosis, the risk of death was less with aortic insufficiency [hazard ratio (95% confidence interval) 0.79 (0.74, 0.84)] and mixed aortic valve disease [0.83 (0.74, 0.93)]. Female gender, admission year, and hypertension were associated with lower mortality in patients with aortic stenosis. Patients with aortic stenosis had increased risk of death or heart failure (adjusted P < 0.001). Of all, 3673 (19.4%) patients had a first aortic valve replacement of whom 73.2% had aortic stenosis, 11.9% aortic valve disease (unspecified),10.0% aortic insufficiency, and 4.9% aortic stenosis with insufficiency. Patients with aortic stenosis with insufficiency had increased likelihood of aortic valve replacement [1.19 (1.02, 1.38)]. Age, female gender, and co-morbidity reduced the likelihood of aortic valve replacement.

Conclusion: The incidence of aortic valve stenosis has substantially increased in Scotland in recent years. Aortic stenosis predicts morbidity and mortality when compared with other types of aortic valve disease.

Keywords: Aortic stenosis; Aortic valve; Epidemiology; Prognosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aortic Valve Insufficiency / mortality*
  • Aortic Valve Insufficiency / therapy
  • Aortic Valve Stenosis / mortality*
  • Aortic Valve Stenosis / therapy
  • Cause of Death
  • Coronary Artery Bypass / mortality
  • Coronary Artery Bypass / statistics & numerical data
  • Female
  • Heart Failure / mortality
  • Heart Valve Prosthesis Implantation / mortality
  • Heart Valve Prosthesis Implantation / statistics & numerical data
  • Hospitalization / statistics & numerical data*
  • Hospitalization / trends
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy
  • Percutaneous Coronary Intervention / mortality
  • Percutaneous Coronary Intervention / statistics & numerical data
  • Prognosis
  • Retrospective Studies
  • Scotland / epidemiology
  • Socioeconomic Factors
  • Stroke / mortality
  • Stroke / therapy