The changing course of aortic valve disease in Scotland: temporal trends in hospitalizations and mortality and prognostic importance of aortic stenosis

• Published in: European heart journal 2013-06, Vol.34 (21), p.1538-1547
• Main Authors: Berry, Colin, Lloyd, Suzanne M, Wang, Yanzhong, Macdonald, Alyson, Ford, Ian
• Format: Article
• Language: English
• Subjects: 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
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehs339

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