Abstract
Background: Trends in mortality from aortic stenosis across European countries are not well-understood, especially given the significant growth in transcatheter aortic valve implantation (TAVI) in the last 10 years.Methods: Age-standardised death rates were extracted from the World Health Organisation Mortality Database, using the International Classification of Diseases 10th edition code for non-rheumatic aortic stenosis for those aged > 45 years between 2000 and 2017. The UK and countries from the European Union with at least 1,000,000 inhabitants and at least 50% available datapoints over the study period were included: a total of 23 countries. Trends were described using Joinpoint regression analysis.Results: No reductions in mortality were demonstrated across all countries 2000–2017. Large increases in mortality were found for Croatia, Poland and Slovakia for both sexes (>300% change). Mortality plateaued in Germany from 2008 in females and 2012 in males, whilst mortality in the Netherlands declined for both sexes from 2007. Mortality differences between the sexes were observed, with greater mortality for males than females across most countries.Conclusions: Mortality from aortic stenosis has increased across Europe from 2000 to 2017. There are, however, sizable differences in mortality trends between Eastern and Western European countries. The need for health resource planning strategies to specifically target AS, particularly given the expected increase with ageing populations, is highlighted.
Highlights
Aortic stenosis (AS) is the most prevalent valvular heart disease in Europe [1]
The tenth revision International Classification of Disease (ICD) code for nonrheumatic AS (I35.0) was used, whilst ICD codes pertaining to aortic insufficiency or mixed aortic valve disease were excluded
In this study we report age standardised death rate (ASDR) per 1,000,000 population, as performed previously [11]
Summary
Aortic stenosis (AS) is the most prevalent valvular heart disease in Europe [1]. Rheumatic heart disease is the most common aetiology worldwide, degenerative calcification of native trileaflet valves and congenital bicuspid valves are the primary causes in developed countries. AS prevalence increases significantly with advancing age and is ∼10% over the age of 80 [2]. With ageing populations, the burden is expected to increase further [3]. AS prognosis relates predominantly to severity and symptoms, with over 50% mortality at 1-year with conservative treatment for severe symptomatic AS [4]. Trends in mortality from aortic stenosis across European countries are not well-understood, especially given the significant growth in transcatheter aortic valve implantation (TAVI) in the last 10 years
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