Abstract
BackgroundIn middle income countries, the burden of rheumatic heart disease (RHD) remains high, but the prevalence of other heart valve diseases may rise as the population life expectancy increases. Here, we compared population-based data on surgical procedures to assess the relative importance of causes of heart valve disease in Salvador, Brazil.Methodology/Principal FindingsMedical charts of patients who underwent surgery for valvular heart disease from January 2002–December 2005 were reviewed. Incidence of surgery for valvular heart disease was calculated. Logistic regression was used to identify factors associated with in-hospital death following surgery. The most common etiologies for valvular dysfunction in 491 valvular heart surgery patients were RHD (60.3%), degenerative valve disease (15.3%), and endocarditis (4.5%). Mean annual incidence for surgeries due to any valvular heart diseases, RHD, and degenerative valvular disease were 5.02, 3.03, and 0.77 per 100,000 population, respectively. Incidence of surgery due to RHD was highest in young adults; procedures were predominantly paid by the public health sector. In contrast, the incidence of surgery due to degenerative valvular disease was highest among those older than 60 years of age; procedures were mostly paid by the private sector. The overall in-hospital case-fatality ratio was 11.9%. Independent factors associated with death included increase in age (odds ratio: 1.04 per year of age; 95% confidence interval: 1.02–1.06), endocarditis (6.35; 1.92–21.04), multiple valve operative procedures (4.35; 2.12–8.95), and prior heart valve surgery (2.49; 1.05–5.87).Conclusions/SignificanceRHD remains the main cause for valvular heart surgery in Salvador, which primarily affects young adults without private health insurance. In contrast, surgery due to degenerative valvular disease primarily impacts the elderly with private health insurance. Strategies to reduce the burden of valvular heart disease will need to address the disparate factors that contribute to RHD as well as degenerative valve disease.
Highlights
The global epidemiology of valvular heart disease has changed dramatically in the past century [1,2,3]
Multivariable analyses including age, sex, surgery payment source, underlying valve disease etiology, number of operated valves, and history of prior heart valve surgery found that the likelihood of in-hospital death following a cardiac valve surgery increased 4% (OR: 1.04; 95% CI: 1.02–1.06) for every year of increase in age, was six times higher for patients with endocarditis as the underlying valve disease (OR: 6.35; 95% CI: 1.92–21.04), were four times higher for patients undergoing surgery in two or more valves (OR: 4.35; 95% CI: 2.12–8.95), and 2.5 times higher for patients with a prior history of heart valve surgery (OR: 2.49; 95% CI: 1.05–5.87) (Table 3)
Our findings show that the epidemiology of valvular heart disease surgeries in Brazil still more closely resembles that of developing countries than that
Summary
The global epidemiology of valvular heart disease has changed dramatically in the past century [1,2,3]. Rheumatic heart disease (RHD) was the leading cause of valvular disease before World War II. The introduction of antibiotics and improved access to health care contributed to a substantial reduction in the incidence of RHD in the second half of the 20th century in developed countries [4]. Degenerative valvular disease is the most common valvular disease in developed countries [4]. The burden of rheumatic heart disease (RHD) remains high, but the prevalence of other heart valve diseases may rise as the population life expectancy increases. We compared population-based data on surgical procedures to assess the relative importance of causes of heart valve disease in Salvador, Brazil
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