Abstract 259: Impact of Valvular Heart Disease on 1-Year Mortality in Veterans

Abstract

Background: The impact of valvular heart disease (VHD) on outcomes in the Veteran population has not been well studied, especially in the contemporary era. Methods: The study population included 244 Veterans who were seen in Cardiology Clinic in January 2015 - of which 190 had a recent echocardiogram at the time of visit. Veterans with evidence of VHD (defined as any evidence of aortic stenosis (AS), > 2+ moderate mitral regurgitation (MR), and/or > 2+ tricuspid regurgitation(TR)) were identified and characteristics of Veterans with and without VHD were evaluated. Differences in one-year rates of major adverse cardiac events (MACE) (a composite of all-cause mortality or cardiovascular hospitalization) were compared for Veterans with VHD versus those without. Results: Of these 190 Veterans, 39 (20.5%) had evidence of valvular heart disease - 19 (10.0%) has any grade of AS, 15 (7.4%) has > 2+ MR, and 18 (9.5%) has > 2+ TR. Veterans with VHD were older (77 vs 68 years, p<0.001), had higher rates of prior coronary artery bypass graft surgery (41.0% vs 21.9%, p=0.015), had higher serum creatinine (1.8 vs 1.2 mg/dl, p=0.002) and lower hemoglobin (12.5 mg/dl vs 13.4mg/dl, p=0.003), higher right ventricular systolic pressure (47 vs 32mmHg, p<0.001) and higher left atrial volume (107 vs 79ml, p<0.001). Rates of MACE and all-cause mortality at 1 year were significantly higher for Veterans with VHD than those without (See Figure). VHD was associated with 1-year mortality [odds ratio (OR) 8.04, 95% confidence interval (CI) 2.22-29.11.35) in Veterans. Conclusions: In Veterans with cardiovascular disease, presence of VHD is associated with higher rates of MACE and all-cause mortality at 1 year. Further research on VHD specifically in the Veteran population is warranted.