Counting the cost of premature mortality with progressively worse aortic stenosis in Australia: a clinical cohort study

Stewart, Simon; Afoakwah, Clifford; Chan, Yih-Kai; Strom, Jordan B.; Playford, David; Strange, G.

doi:10.1016/s2666-7568(22)00168-4

Cited by 14 publications

(20 citation statements)

References 31 publications

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“…When compared with absence of aortic stenosis, any degree of aortic stenosis was associated with eight more premature deaths in men resulting in 32•5 more QALYs lost (societal cost of $1•40 million) and 12 more premature deaths in women resulting in 57•5 more QALYs lost (societal cost of $2•48 million) when compared to those without aortic stenosis. 4 This considerable burden increased with worsening aortic stenosis severity, as expected, but was obvious and substantial with mild aortic stenosis.…”

Section: Live Longer and Better Without Aortic Valve Stenosissupporting

confidence: 61%

“…The important findings reported by Stewart and colleagues 4 provide a strong impetus to action. First, action is needed to improve detection of aortic stenosis at the primary care level by systematic annual cardiac auscultation, especially in people older than 65 years, or…”

Section: Live Longer and Better Without Aortic Valve Stenosismentioning

confidence: 93%

“…There is growing body of evidence supporting the performance of earlier intervention before the onset of symptoms and several randomised controlled trials are currently being conducted to test this hypothesis. The association reported by Stewart and colleagues 4 between aortic stenosis of any degree and mortality might also be related, at least in part, to the effect of other comorbidities frequently associated with aortic stenosis (eg, diabetes, hypertension, or coronary artery disease) or progression to more severe degree of aortic stenosis during follow-up.…”

Section: Live Longer and Better Without Aortic Valve Stenosismentioning

confidence: 94%

“…1 Furthermore, the prevalence of aortic stenosis is expected to triple by the next 30 years in high-income countries due to ageing of the population. 1 The novel data reported by Stewart and colleagues 4 demonstrate that not only severe aortic stenosis but also mild and moderate degrees of aortic stenosis might significantly reduce the longevity and quality of life of people aged 65 years or older. With these new findings, we can anticipate that the burden related to aortic stenosis will rapidly become unsustainable for our health-care systems and that transformative actions should implemented urgently to mitigate this burden.…”

Section: Live Longer and Better Without Aortic Valve Stenosismentioning

confidence: 99%

“…In the past 5 years, some studies suggested that moderate aortic stenosis might also have a negative impact on survival. 3 In this issue of The Lancet Healthy Longevity, Simon Stewart and colleagues 4 present the results of a nation-wide observational clinical cohort study, in which they examined echocardiograms on native aortic valves of 98 565 men and 99 357 women aged 65 years and older across 23 sites in Australia. The key finding of this study is that any degree (ie, mild, moderate, or severe) of aortic stenosis is associated with incremental premature mortality and loss in quality adjusted life years (QALYs) in older individuals.…”

Section: Live Longer and Better Without Aortic Valve Stenosismentioning

confidence: 99%

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Live longer and better without aortic valve stenosis

Clavel¹

2022

The Lancet Healthy Longevity

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Section: Live Longer and Better Without Aortic Valve Stenosissupporting

confidence: 61%

Section: Live Longer and Better Without Aortic Valve Stenosismentioning

confidence: 93%

Section: Live Longer and Better Without Aortic Valve Stenosismentioning

confidence: 94%

Section: Live Longer and Better Without Aortic Valve Stenosismentioning

confidence: 99%

Section: Live Longer and Better Without Aortic Valve Stenosismentioning

confidence: 99%

See 3 more Smart Citations

Live longer and better without aortic valve stenosis

Clavel¹

2022

The Lancet Healthy Longevity

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Left-sided valvular heart disease and survival in out-of-hospital cardiac arrest: a nationwide registry-based study

Dejby

Bhatt

Skoglund

et al. 2023

Sci Rep

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Survival in left-sided valvular heart disease (VHD; aortic stenosis [AS], aortic regurgitation [AR], mitral stenosis [MS], mitral regurgitation [MR]) in out-of-hospital cardiac arrest (OHCA) is unknown. We studied all cases of OHCA in the Swedish Registry for Cardiopulmonary Resuscitation. All degrees of VHD, diagnosed prior to OHCA, were included. Association between VHD and survival was studied using logistic regression, gradient boosting and Cox regression. We studied time to cardiac arrest, comorbidities, survival, and cerebral performance category (CPC) score. We included 55,615 patients; 1948 with AS (3,5%), 384 AR (0,7%), 17 MS (0,03%), and 704 with MR (1,3%). Patients with MS were not described due to low case number. Time from VHD diagnosis to cardiac arrest was 3.7 years in AS, 4.5 years in AR and 4.1 years in MR. ROSC occurred in 28% with AS, 33% with AR, 36% with MR and 35% without VHD. Survival at 30 days was 5.2%, 10.4%, 9.2%, 11.4% in AS, AR, MR and without VHD, respectively. There were no survivors in people with AS presenting with asystole or PEA. CPC scores did not differ in those with VHD compared with no VHD. Odds ratio (OR) for MR and AR showed no difference in survival, while AS displayed OR 0.58 (95% CI 0.46–0.72), vs no VHD. AS is associated with halved survival in OHCA, while AR and MR do not affect survival. Survivors with AS have neurological outcomes comparable to patients without VHD.

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Development and validation of the Aortic valve Stenosis Guarded by Amplified Risk Determination (ASGARD) risk score for safe monitoring in asymptomatic non-severe aortic valve stenosis

Hadziselimovic,

Greve,

Sajadieh

et al. 2024

European Journal of Preventive Cardiology

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Aims Current guidelines recommend serial echocardiography at minimum 1-2 year intervals for monitoring patients with nonsevere aortic valve stenosis (AS), which is costly and often clinically inconsequential. We aimed to develop and test whether the biomarker-based ASGARD risk score (Aortic Valve Stenosis Guarded by Amplified Risk Determination) can guide the timing of echocardiograms in asymptomatic patients with nonsevere AS. Methods The development cohort comprised 1,093 of 1,589 (69%) asymptomatic patients with mild-to-moderate AS who remained event-free one year after inclusion into the SEAS trial. Cox regression landmark analyses with a 2-year follow-up identified the model (ASGARD) with the lowest Akaike information criterion for association to AS-related composite outcome (heart failure hospitalization, aortic valve replacement, or cardiovascular death). Fine-Gray analyses provided cumulative event rates by ASGARD score quartiles. The ASGARD score was internally validated in the remaining 496 patients (31%) from the SEAS-cohort and externally in 71 asymptomatic outpatients with nonsevere AS from six Copenhagen hospitals. Results The ASGARD score comprises updated measurements of heart rate and age- and sex-adjusted N-terminal pro-brain natriuretic peptide upon transaortic maximal velocity (Vmax) from the previous year. The ASGARD score had high predictive accuracy across all cohorts (external validation: area under the curve: 0.74 [95% CI, 0.62-0.86]), and similar to an updated Vmax measurement. An ASGARD score ≤50% was associated with AS-related event rates ≤5% for a minimum of 15 months. Conclusion The ASGARD score could provide a personalized and safe surveillance alternative to routinely planned echocardiograms, so physicians can prioritize echocardiograms for high-risk patients.

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Counting the cost of premature mortality with progressively worse aortic stenosis in Australia: a clinical cohort study

Cited by 14 publications

References 31 publications

Live longer and better without aortic valve stenosis

Live longer and better without aortic valve stenosis

Left-sided valvular heart disease and survival in out-of-hospital cardiac arrest: a nationwide registry-based study

Development and validation of the Aortic valve Stenosis Guarded by Amplified Risk Determination (ASGARD) risk score for safe monitoring in asymptomatic non-severe aortic valve stenosis

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