Temporal Trends in Disease Severity and Predicted Surgical Risk at the Time of Referral for Echocardiography in Patients Diagnosed with Aortic Stenosis. Issue 3 (September 2015)

• Record Type: Journal Article
• Authors: Ersboll, Mads; Samad, Zainab; Enezi, Fawaz Al; Kisslo, Joseph; Schulte, Phillip J.; Shaw, Linda K.; Køber, Lars; Harrison, J. Kevin; Bashore, Thomas; Brennan, Matthew; Velazquez, Eric J.
• Is Part Of: Critical pathways in cardiology. Volume 14:Issue 3(2015)
• Publication Date: 2015-09
• Subjects: aortic stenosis -- aortic valve replacement -- echocardiography -- health services research -- high-risk populations; Cardiology -- Periodicals; Evidence-based medicine -- Periodicals; Medical protocols -- Periodicals; 616.12005
• DOI: 10.1097/HPC.0000000000000048
• Languages: English
• ISSNs: 1535-282X

Abstract

Abstract : Background: Calcific aortic stenosis (AS) is the most common underlying pathology in patients undergoing heart valve surgery, with an expected increasing prevalence among the aging population. Methods and Results: We identified the temporal trends in referral patterns, disease severity, and associated surgical risk among patients with AS between January 1, 1995 and December 31, 2012 at the Duke University Hospital. A total of 6103 patients had a finding of mild (n = 3303), moderate (n = 1648), or severe AS (n = 1152) in a native aortic valve. Overall presence of severe AS increased significantly over time ( P = 0.009) with the most substantial increase occurring from 2010 and onward. Median age upon referral ( P < 0.001) and attendant predicted surgical risk ( P < 0.001) increased significantly in the observation period among patients with a finding of severe AS. Among patients with a finding of severe AS, the proportion of patients aged older than 80 years increased to 51.0% in the most recent time period (2010–2012) compared with 32.6% in the preceding time period ( P < 0.001 for overall time trend). Similarly, the proportion of patients with a logistic EuroSCORE greater than 20% increased to 21.3% (2010–2012) from 12.1% (pre-2010). Conclusions: Among patients referred for echocardiography to a high-volume tertiary hospital center, a significant increase in the prevalence of severe AS was observed over time. This trend occurred in parallel with increasing age and predicted surgical risk at referral. Health-care resource planning should account for an increasing number of patients in need of high-risk aortic valve replacements in the near future.