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Multicenter Study
. 2021 Sep;107(18):1493-1502.
doi: 10.1136/heartjnl-2021-319025. Epub 2021 Jun 2.

Cumulative burden of clinically significant aortic stenosis in community-dwelling older adults

David S Owens  1 , Traci M Bartz  2 , Petra Buzkova  2 , Daniele Massera  3 , Mary L Biggs  2 , Selma D Carlson  4 , Bruce M Psaty  5 , Nona Sotoodehnia  1   5 , John S Gottdiener  6 , Jorge R Kizer  7   8
Affiliations
Multicenter Study

Cumulative burden of clinically significant aortic stenosis in community-dwelling older adults

David S Owens et al. Heart. 2021 Sep.

Abstract

Objectives: Current estimates of aortic stenosis (AS) frequency have mostly relied on cross-sectional echocardiographic or longitudinal administrative data, making understanding of AS burden incomplete. We performed case adjudications to evaluate the frequency of AS and assess differences by age, sex and race in an older cohort with long-term follow-up.

Methods: We developed case-capture methods using study echocardiograms, procedure and diagnosis codes, heart failure events and deaths for targeted review of medical records in the Cardiovascular Health Study to identify moderate or severe AS and related procedures or hospitalisations. The primary outcome was clinically significant AS (severe AS or procedure). Assessment of incident AS burden was based on subdistribution survival methods, while associations with age, sex and race relied on cause-specific survival methods.

Results: The cohort comprised 5795 participants (age 73±6, 42.2% male, 14.3% Black). Cumulative frequency of clinically significant AS at maximal 25-year follow-up was 3.69% (probable/definite) to 4.67% (possible/probable/definite), while the corresponding 20-year cumulative incidence was 2.88% to 3.71%. Of incident cases, about 85% had a hospitalisation for severe AS, but roughly half did not undergo valve intervention. The adjusted incidence of clinically significant AS was higher in men (HR 1.62 [95% CI 1.21 to 2.17]) and increased with age (HR 1.08 [95% CI 1.04 to 1.11]), but was lower in Blacks (HR 0.43 [95% CI 0.23 to 0.81]).

Conclusions: In this community-based study, we identified a higher burden of clinically significant AS than reported previously, with differences by age, sex and race. These findings have important implications for public health resource planning, although the lower burden in Blacks merits further study.

Keywords: aortic valve stenosis; epidemiology.

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Conflict of interest statement

Competing interests: JRK discloses stock ownership in Abbott, Bristol-Myers Squibb, Johnson & Johnson, Medtronic, Merck and Pfizer.

Figures

Figure 1.
Figure 1.
Cumulative Incidence Plots of AS Events and Death. Subdistribution and cause-specific AS refer to the plot for each aortic stenosis outcome calculated by subdistrubtion survival methods and cause specific survival methods, respectively. AS = aortic stenosis.
Figure 2.
Figure 2.
Cumulative Incidence of AS Events and Death at 10, 15 and 20 Years of Follow-Up. AS = aortic stenosis; y = years.
See this image and copyright information in PMC

Comment in

  • Community burden of aortic valve disease.
    Iung B, Arangalage D. Iung B, et al. Heart. 2021 Sep;107(18):1446-1447. doi: 10.1136/heartjnl-2021-319560. Epub 2021 Jun 14. Heart. 2021. PMID: 34127542 No abstract available.

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