Large-scale community echocardiographic screening reveals a major burden of undiagnosed valvular heart disease in older people: the OxVALVE Population Cohort Study

d’Arcy, Joanna; Coffey, Sean; Loudon, Margaret; Kennedy, Andrew; Pearson‐Stuttard, Jonathan; Birks, Jacqueline; Frangou, Eleni; Farmer, Andrew; Mant, David; Wilson, Jo; Myerson, Saul G.; Prendergast, Bernard

doi:10.1093/eurheartj/ehw229

Cited by 447 publications

(348 citation statements)

References 37 publications

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“…We found that low education predicted aortic regurgitation. Education is an established proxy for socioeconomic status that, in turn, is associated with risk of cardiovascular disease, including valvular disease 28, 29. Thus, our data are in line with previous observations.…”

Section: Discussionsupporting

confidence: 92%

Traditional Cardiovascular Risk Factors and Their Relation to Future Surgery for Valvular Heart Disease or Ascending Aortic Disease: A Case–Referent Study

Ljungberg

Johansson

Engström

et al. 2017

JAHA

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BackgroundRisk factors for developing heart valve and ascending aortic disease are based mainly on retrospective data. To elucidate these factors in a prospective manner, we have performed a nested case–referent study using data from large, population‐based surveys.Methods and ResultsA total of 777 patients operated for heart valve disease or disease of the ascending aorta had previously participated in population‐based health surveys in Northern Sweden. Median time (interquartile range) from survey to surgery was 10.5 (9.0) years. Primary indications for surgery were aortic stenosis (41%), aortic regurgitation (12%), mitral regurgitation (23%), and dilatation/dissection of the ascending aorta (17%). For each case, referents were allocated, matched for age, sex, and geographical area. In multivariable models, surgery for aortic stenosis was predicted by hypertension, high cholesterol levels, diabetes mellitus, and active smoking. Surgery for aortic regurgitation was associated with a low cholesterol level, whereas a high cholesterol level predicted surgery for mitral regurgitation. Hypertension, blood pressure, and previous smoking predicted surgery for disease of the ascending aorta whereas diabetes mellitus was associated with reduced risk. After exclusion of cases with coronary atherosclerosis, only the inverse associations between cholesterol and aortic regurgitation and between diabetes mellitus and disease of the ascending aorta remained.ConclusionsThis is the first truly prospective study of traditional cardiovascular risk factors and their association with valvular heart disease and disease of the ascending aorta. We confirm the strong association between traditional risk factors and aortic stenosis, but only in patients with concomitant coronary artery disease. In isolated valvular heart disease, the impact of traditional risk factors is varying.

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Section: Discussionsupporting

confidence: 92%

Traditional Cardiovascular Risk Factors and Their Relation to Future Surgery for Valvular Heart Disease or Ascending Aortic Disease: A Case–Referent Study

Ljungberg

Johansson

Engström

et al. 2017

JAHA

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“…Integration of echocardiography screening strategies with the existing SUS may be a future direction and has been successfully evaluated in different settings. Even in high‐resourced regions, like the United Kingdom, population‐based echocardiographic screening of asymptomatic elderly individuals was feasible, and the presence of valve disease was associated with socioeconomic status 34. In low‐income areas, such as India, a mass screening strategy in rural areas with focused handheld echocardiography performed by nonexperts and remote interpretation, similar to the PROVAR study flow chart, was also successful and revealed an alarming 16% of major echocardiographic abnormalities (32.9% valve disease), with an important contribution of RHD 35…”

Section: Discussionmentioning

confidence: 99%

Comparison Between Different Strategies of Rheumatic Heart Disease Echocardiographic Screening in Brazil: Data From the PROVAR (Rheumatic Valve Disease Screening Program) Study

Nascimento

Sable

Nunes

et al. 2018

JAHA

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BackgroundConsidering the limited accuracy of clinical examination for early diagnosis of rheumatic heart disease (RHD), echocardiography has emerged as an important epidemiological tool. The ideal setting for screening is yet to be defined. We aimed to evaluate the prevalence and pattern of latent RHD in schoolchildren (aged 5–18 years) and to compare effectiveness of screening between public schools, private schools, and primary care centers in Minas Gerais, Brazil.Methods and ResultsThe PROVAR (Rheumatic Valve Disease Screening Program) study uses nonexperts and portable and handheld devices for RHD echocardiographic screening, with remote interpretation by telemedicine, according to the 2012 World Heart Federation criteria. Compliance with study consent and prevalence were compared between different screening settings, and variables associated with RHD were analyzed. In 26 months, 12 048 students were screened in 52 public schools (n=10 901), 2 private schools (n=589), and 3 primary care centers (n=558). Median age was 12.9 years, and 55.4% were girls. Overall RHD prevalence was 4.0% borderline (n=486) and 0.5% definite (n=63), with statistically similar rates between public schools (4.6%), private schools (3.5%), and primary care centers (4.8%) (P=0.24). The percentage of informed consents signed was higher in primary care centers (84.4%) and private schools (66.9%) compared with public schools (38.7%) (P<0.001). Prevalence was higher in children ≥12 years (5.3% versus 3.1%; P<0.001) and girls (4.9% versus 4.0%; P=0.02). Only age (odds ratio, 1.12; 95% confidence interval, 1.09–1.17; P<0.001) was independently associated with RHD.Conclusions RHD screening in primary care centers seems to achieve higher coverage rates. Prevalence among schoolchildren is significantly high, with rates higher than expected in private schools of high‐income areas. These data are important for the formulation of public policies to confront RHD.

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“…U budućnosti bi prikladna metoda zbrinjavanja A large-scale echocardiographic screening involving 2500 individuals aged > 65 years was conducted to detect undiagnosed VHD (Figure 1). 1 Clinically significant (moderate or severe) undiagnosed VHD was identified in 6.4%. In addition, 4.9% of the cohort had pre-existing VHD (a total prevalence of 11.3%).…”

Section: Aortna Stenozamentioning

confidence: 96%

“…1 Klinički bitna, no još nedijagnosticirana bolest srčanih zalistaka (umjerenoga ili teškoga stupnja) utvrđena je u 6,4 % osoba. U navedenoj kohorti 4,9 % osoba imalo je već poznatu bolest srčanih zalistaka (ukupna prevalencija 11,3 %).…”

Section: Preambleunclassified

The year in cardiology 2016: valvular heart disease

Alfieri¹,

Vahanian²

2017

Cardiologia Croatica

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Large-scale community echocardiographic screening reveals a major burden of undiagnosed valvular heart disease in older people: the OxVALVE Population Cohort Study

Cited by 447 publications

References 37 publications

Traditional Cardiovascular Risk Factors and Their Relation to Future Surgery for Valvular Heart Disease or Ascending Aortic Disease: A Case–Referent Study

Traditional Cardiovascular Risk Factors and Their Relation to Future Surgery for Valvular Heart Disease or Ascending Aortic Disease: A Case–Referent Study

Comparison Between Different Strategies of Rheumatic Heart Disease Echocardiographic Screening in Brazil: Data From the PROVAR (Rheumatic Valve Disease Screening Program) Study

The year in cardiology 2016: valvular heart disease

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