Temporal trends and socioeconomic differences in treatment and mortality following a diagnosis of aortic stenosis

Lene Von Kappelgaard,Gunnar Gislason,Michael Davidsen,Ann-Dorthe Zwisler,Knud Juel

doi:10.1016/j.ijcard.2021.05.039

Lene Von Kappelgaard, Gunnar Gislason + Show 3 more

Open Access

https://doi.org/10.1016/j.ijcard.2021.05.039

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Abstract

AimsThis study aims at determining the temporal trends and the socioeconomic differences in treatment and mortality following a diagnosis of aortic stenosis. Methods and resultsA total of 45,026 patients with a first-time diagnosis of aortic stenosis were identified in the Danish National Patient Registry in the period 2000–17. The risk of AVR within the first year after diagnosis decreased (OR = 1.84 in 2000–02 compared to 2015–16) and the risk was lower in the low-level educational group (OR = 0.85) and in the medium-level group (OR = 0.94) compared to high-level education. The risk of death after AVR within the first year decreased (OR = 2.25 in 2000–02 compared to 2015–16) and the risk was higher in the low-level educational group (OR = 1.32) and in the medium-level group (OR = 1.28) compared to high-level education. The risk of death within the first year after diagnosis, for those patients who did not get an AVR during the follow-up, decreased (OR = 3.08 in 2000–02 compared to 2015–16) and the risk was higher in the low-level educational group (OR = 1.21) and in the medium-level group (OR = 1.10) compared to high-level education. ConclusionSince 2000 there has been a decrease in both AVR treatment rate, mortality rate after AVR and mortality rate in patients not receiving AVR. For patients with lower-level education there is lower AVR treatment rate, higher mortality rate after AVR and higher mortality rate in patients not receiving AVR.

Highlights

Aortic stenosis is the most common valvular heart disease and it is primarily a disease of the elderly [1,2,3]
We identified 45,026 patients between the age of 30 and 79 years with a first-time diagnosis of aortic stenosis in the period 2000–17 (Table 1)
The crude proportion of patients treated with aortic valve replacement (AVR) within the first year from diagnosis declined over time (Table 1)

Summary

Introduction

Aortic stenosis is the most common valvular heart disease and it is primarily a disease of the elderly [1,2,3]. With the ageing of the western populations, the burden of aortic stenosis is expected to increase [4,5,6,7,8,9]. The majority of aortic stenosis is degenerative and shares risk factors with those of atherosclerosis [7,10,11,12,13,14,15], e.g. hypertension, advanced age, smoking, metabolic syndrome, hyperlipidemia, obesity, diabetes and being male. Aortic stenosis is often characterized by a long, asymptomatic phase in which the mortality is rather low [16,17] followed by a significantly higher mortality after symptom onset. For patients with severe aortic stenosis or patients with onset of symptoms, conservative management is not an option and the only treatment is aortic valve replacement (AVR) [17].

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Conclusion