Temporal Trends in the Incidence and Prognosis of Aortic Stenosis

Abstract

Background-The aging of Western populations is expected to result in increasing occurrence of aortic stenosis (AS), but data are limited. Recent studies have reported declining incidence and mortality for other major heart diseases. We aimed to study temporal trends in the incidence and prognosis for AS in Sweden. Methods and Results-With the use of nationwide registers, all adult patients in the Swedish population with a first diagnosis of AS, heart failure, acute myocardial infarction, and aortic valve replacement for AS between 1989 and 2009 were identified and followed up until the end of 2010 for all-cause and cardiovascular-related mortality. The age-adjusted incidence of AS in Sweden declined from 15.0 to 11.4 in men and 9.8 to 7.1 in women per 100 000 between 1989 to 1991 and 2007 to 2009, and the median age at diagnosis increased by 4 years for both men and women. The age-and sexadjusted relative risk of 1-and 3-year mortality in 2007 to 2009 was 0.58 (95% confidence interval, 0.53-0.63) and 0.60 (95% confidence interval, 0.56-0.65), respectively, compared with 1989 to 1991. Similar improvements were observed for heart failure and acute myocardial infarction. Findings were broadly consistent across subgroups. Postoperative mortality at 30 days declined despite increased median age at diagnosis. Conclusions-Incidence and mortality rates in AS in Sweden declined between 1989 and 2009 to an extent similar to that observed for heart failure and acute myocardial infarction. These findings could suggest that improved risk factor control and cardiovascular therapy, combined with increased use of aortic valve replacement in the elderly and reduced perioperative mortality in aortic valve replacement, have translated into favorable effects for AS.

Population-Wide Trends in Aortic Stenosis Incidence and Outcomes

“…Thus, a more complete picture of the incidence (and outcomes) could be obtained by a sharper analysis of the echocardiographic data rather than by relying on more crude administrative data. These concerns do not detract from the important observations by Martinsson et al 16 regarding the very favorable trends in mortality for aortic stenosis, heart failure, and myocardial infarction related to lifestyle, preventive therapies, and interventions, in keeping with those witnessed in the United States over the past several decades. 18 These national data appear to fully capture all patients with aortic stenosis, which is a unique strength of this database.…”

“…The data reported by Martinsson et al 16 from 1989 through 2009 represent inpatient data and, thus, presumably identify those patients with hospitalizations related to symptomatic aortic stenosis who ultimately underwent surgery, those with symptomatic aortic stenosis deemed too high risk for surgery, or those in whom aortic stenosis was a secondary diagnosis made during a hospitalization for heart failure, acute myocardial infarction, or other unrelated conditions. Because aortic valve replacement was performed in 37.0% to 42.5% of patients during this period, it would appear that >50% of patients fit into this latter group, in whom the ascertainment of disease and severity of aortic stenosis are uncertain.…”

Sex Differences in the Utilization and Outcomes of Surgical Aortic Valve Replacement for Severe Aortic Stenosis

“…Among 113 847 patients admitted with an aortic valve disorder diagnosis in the United States, 55.1% were men 21. A similar study in Sweden showed that men constituted 52% of all patients newly diagnosed with AS 22. Even a lower incidence of new AS diagnosis in men was observed in a large Scottish registry of 19 733 patients, of whom 46.8% were men 23.…”

Risk Factors for Progression of Degenerative Aortic Valve Disease in the Japanese – The Japanese Aortic Stenosis Study (JASS) Prospective Analysis –

“…The JASS Prospective Analysis enrolled 359 Japanese subjects who met the following criteria: (1) 50 years old or more; (2) markedly increased reflectivity (calcification) of any aortic valve leaflet or peak aortic transvalvular flow velocity of at least 2 m/s on echocardiography performed between 2007 and 2010; (3) agreement to participate in this study, and (4) to undergo annual echocardiography for 3 years. Subjects with rheumatic valvular disease or who had undergone AVR were excluded.…”