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. 2022 Apr 12;2(3):354-365.
doi: 10.1016/j.jacasi.2021.11.013. eCollection 2022 Jun.

Distribution, Characteristics, and Management of Older Patients With Valvular Heart Disease in China: China-DVD Study

Haiyan Xu  1 , Qingrong Liu  1 , Kai Cao  2 , Yunqing Ye  1 , Bin Zhang  1 , Zhe Li  1 , Jie Hao  1 , Xiling Qi  1 , Qinghao Zhao  1 , Sisi Liu  1 , Runlin Gao  1 , Yongjian Wu  1 ; China-DVD Study Investigators
Affiliations

Distribution, Characteristics, and Management of Older Patients With Valvular Heart Disease in China: China-DVD Study

Haiyan Xu et al. JACC Asia. .

Abstract

Background: The epidemiology and management of valvular heart disease (VHD) have changed with economic development and population aging in China in recent decades.

Objectives: This study sought to understand the distribution, etiology, and presentation and assess the current practice and outcomes of older patients with VHD in China.

Methods: The authors conducted the first nationwide survey of older patients with VHD between September and December 2016 from 69 hospitals in 28 provinces and municipalities throughout China. Hospitalized patients over 60 years of age with moderate-to-severe VHD, infective endocarditis, or previous valvular intervention were consecutively enrolled.

Results: Of 8,929 patients (median age of 69 years, 47.5% female), 8227 (92.1%) had native VHD. Mitral regurgitation was the most prevalent single VHD (26.9% of native VHD), followed by tricuspid regurgitation (16.5%), aortic regurgitation (10.6%), aortic stenosis (5.1%), and mitral stenosis (3.1%). Degenerative (37.2%), functional (21.8%), and rheumatic (15.0%) etiologies were the 3 most common causes. Among symptomatic patients with severe VHD, 37.3% underwent valvular intervention. The intervention rates decreased significantly with age across all types of VHD (P trend < 0.01). Valvular surgery covered 93.7% of interventions. The overall 1-year survival rate was 74.4% (95% CI: 63.4%-85.4%).

Conclusions: This study provides a unique national insight into the contemporary spectrum and management of older VHD patients in China. With the increase in the health care demand, more resources and efforts are required for early detection, effective intervention, and targeting innovation on advanced therapeutic techniques and devices to improve the outcomes.

Keywords: AR, aortic regurgitation; AS, aortic stenosis; CT, computed tomography; LVEF, left ventricular ejection fraction; MR, mitral regurgitation; MS, mitral stenosis; RHD, rheumatic heart disease; TAVR, transcatheter aortic valve replacement; TR, tricuspid regurgitation; VHD, valvular heart disease; epidemiology; intervention; valvular heart disease.

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Conflict of interest statement

This work was supported by National Twelfth Five-year Science and Technology Support Projects by Ministry of Science and Technology of China (Grant No. 2015BAI12B02). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Central Illustration
Central Illustration
Distribution and Intervention of Older Patients With VHD (A) Distribution of patients with native valvular heart disease (VHD). (B) Distribution of patients with severe native VHD. (C) The intervention rates among severe symptomatic patients according to types of VHD. (D) The intervention rates among severe symptomatic patients according to age groups. P values were <0.01 for all trends. AR = aortic regurgitation; AS = aortic stenosis; MR = mitral regurgitation; MS = mitral stenosis.
Figure 1
Figure 1
Venn Diagram on Distribution of Single and Multiple Native Valve Disease Venn diagram demonstrate the composition of isolated, mixed and multiple valve lesions and the numbers of these patients. AR = aortic regurgitation; AS = aortic stenosis; MR = mitral regurgitation; MS = mitral stenosis; TR = tricuspid regurgitation.
Figure 2
Figure 2
Etiology of Native Valve Disease in Older Patients The bar chart represents the proportions of different etiologies in patients with native valve diseases. Abbreviations as in Figure 1.
Figure 3
Figure 3
1-Year Survival Rates of Older Patients With Native Moderate or Severe Valve Disease The Kaplan-Meier curves of one-year survival are shown according to different VHD in patients with moderate or severe valve diseases. VHD = valvular heart disease; other abbreviations as in Figure 1.
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