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. 2020 Aug 4;9(15):e016086.
doi: 10.1161/JAHA.120.016086. Epub 2020 Jul 22.

Dismal Outcomes and High Societal Burden of Mitral Valve Regurgitation in France in the Recent Era: A Nationwide Perspective

David Messika-Zeitoun  1 , Pascal Candolfi  2 , Alec Vahanian  3   4   5 , Vincent Chan  1 , Ian G Burwash  1 , Jean-François Philippon  6 , Jean-Manuel Toussaint  7 , Patrick Verta  8 , Ted E Feldman  8 , Bernard Iung  3   4   5 , David Glineur  1 , Thierry Mesana  1 , Maurice Enriquez-Sarano  9
Affiliations

Dismal Outcomes and High Societal Burden of Mitral Valve Regurgitation in France in the Recent Era: A Nationwide Perspective

David Messika-Zeitoun et al. J Am Heart Assoc. .

Abstract

Background Although US recent data suggest that mitral regurgitation (MR) is severely undertreated and carries a poor outcome, population-based views on outcome and management are limited. We aimed to define the current treatment standards, clinical outcomes, and costs related to MR at the nationwide level. Methods and Results In total, 107 412 patients with MR were admitted in France in 2014 to 2015. Within 1 year, 8% were operated and 92% were conservatively managed and constituted our study population (68% primary MR and 32% secondary MR). The mean age was 77±15 years; most patients presented with comorbidities. In-hospital and 1-year mortality rates were 4.1% and 14.3%, respectively. Readmissions were common (63% at least once and 37% readmitted ≥2 times). Rates of 1-year mortality or all-cause readmission and 1-year mortality or heart failure readmission were 67% and 34%, respectively, and increased with age, Charlson index, heart failure at admission, and secondary MR etiology; however, the event rate remained notably high in the primary MR subset (64% and 28%, respectively). The mean costs of hospital admissions and of readmissions were 5345±6432 and 10 080±10 847 euros, respectively. Conclusions At the nationwide level, MR was a common reason for admission and affected an elderly population with frequent comorbidities. Less than 10% of patients underwent a valve intervention. All subsets of patients who were conservatively managed incurred high mortality and readmissions rates, and MR represented a major societal burden with an extrapolated annual cost of 350 to 550 million euros (390-615 million US dollars). New strategies to improve the management and outcomes of patients with both primary and secondary MR are critical and warranted.

Keywords: cost; management; mitral valve regurgitation; outcomes.

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Conflict of interest statement

David Messika‐Zeitoun is a consultant for Edwards Lifesciences, Mardil and Cardiawave and receives research grants from Edwards Lifesciences and Abbott vascular. Pascal Candolfi is an Edwards Lifesciences employee. Alec Vahanian has received speaker’s fees from Edwards Lifesciences and Abbott Vascular and is consultant for Cardiawave. Patrick Verta is an Edwards Lifesciences employee. Ted E. Feldman is an Edwards Lifesciences employee. Bernard Iung has received consultant fees from Edwards Lifesciences and speaker’s fees from Boehringer Ingelheim and Novartis. Maurice Enriquez‐Sarano has received research grants from Edwards Lifesciences. The remaining authors have no disclosures to report.

Figures

Figure 1
Figure 1. Flow chart of the population according to management and etiology of the mitral regurgitation.
PMR indicates primary mitral regurgitation; and SMR, secondary mitral regurgitation.
Figure 2
Figure 2. Charlson index distribution overall and according to the etiology (PMR or SMR) of the regurgitation in the 98 736 conservatively managed patients.
PMR indicates primary mitral regurgitation; and SMR, secondary mitral regurgitation.
Figure 3
Figure 3. One‐year event rates (all‐cause mortality, all‐cause mortality or readmission, and all‐cause mortality or readmission for HF) overall and according to the etiology (PMR or SMR) of the regurgitation.
HF indicates heart failure; PMR, primary mitral regurgitation; and SMR, secondary mitral regurgitation.
Figure 4
Figure 4
One‐year event rates (all‐cause mortality, all‐cause mortality or readmission, and all‐cause mortality or readmission for heart failure) according to age categories
Figure 5
Figure 5
One‐year event rates (all‐cause mortality, all‐cause mortality or readmission, and all‐cause mortality or readmission for heart failure) according to Charlson index
Figure 6
Figure 6. Distribution of the costs for first admission (A) and readmissions (B), according to the etiology the regurgitation (PMR in orange and SMR in red) and presence (HF+, hatched) or absence (HF–, solid color) of HF at presentation
. HF indicates heart failure; PMR, primary mitral regurgitation; and SMR, secondary mitral regurgitation.
See this image and copyright information in PMC

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