Abstract
BackgroundWe aimed to address the paucity of information describing the treatable burden of disease associated with severe aortic stenosis (AS) within Australia’s ageing population.MethodsA contemporary model of the population prevalence of symptomatic, severe AS and treatment pathways in Europe and North America was applied to the 2019 Australian population aged ≥ 55 years (7 million people) on an age-specific basis. Applying Australian-specific data, these estimates were used to further calculate the total number of associated deaths and incident cases of severe AS per annum.ResultsBased on an overall point prevalence of 1.48 % among those aged ≥ 55 years, we estimate that a minimum of 97,000 Australians are living with severe AS. With a 2-fold increased risk of mortality without undergoing aortic valve replacement (AVR), more than half of these individuals (∼56,000) will die within 5-years. From a clinical management perspective, among those with concurrent symptoms (68.3 %, 66,500 [95 % CI 59,000–74,000] cases) more than half (58.4 %, 38,800 [95 % CI 35,700 − 42,000] cases) would be potentially considered for surgical AVR (SAVR) - comprising 2,400, 5,400 and 31,000 cases assessed as high-, medium- or low peri-operative mortality risk, respectively. A further 17,000/27,700 (41.6 % [95 % CI 11,600 − 22,600]) of such individuals would be potentially considered to a transthoracic AVR (TAVR). During the subsequent 5-year period (2020–2024), each year, we estimate an additional 9,300 Australians aged ≥ 60 years will subsequently develop severe AS (6,300 of whom will experience concurrent symptoms). Of these symptomatic cases, an estimated 3,700 and 1,600 cases/annum, will be potentially suitable for SAVR and TAVR, respectively.ConclusionsThese data suggest there is likely to be a substantive burden of individuals living with severe AS in Australia. Many of these cases may not have been diagnosed and/or received appropriate treatment (based on the evidence-based application of SAVR and TAVR) to reduce their high-risk of subsequent mortality.
Highlights
One of the most common cardiac conditions affecting the progressively aging populations of high-income countries such as Australia is aortic stenosis (AS) [1]
Given the Australian context, we aimed to expand our burden of disease estimates to those aged ≥ 55 years (noting the original study applied a single estimate of the overall prevalence of severe AS to those aged ≥ 75 years [12]) and by applying age- and sex-specific, incident, and prevalent estimates of AS informed by the recent National Echocardiography Database of Australia (NEDA) Study of AS [3]
Assuming just over two-thirds of these cases experience concurrent symptoms linked to the condition, according to contemporary clinical recommendations/ best practice around 66,500 people might be considered for an aortic valve replacement (AVR) procedure at any one time
Summary
One of the most common cardiac conditions affecting the progressively aging populations of high-income countries such as Australia is aortic stenosis (AS) [1]. Like many other countries, there has been a paucity of reports focusing on the overall prevalence and treatable burden of AS in Australia. A recent AS report from National Echocardiography Database of Australia (NEDA) [3] that assessed the severity of AS and subsequent pattern of survival among 122,809 men and 118,494 women with a mean age of 62 ± 18 years highlighted an urgent need to better understand the burden imposed by this potentially deadly condition. We aimed to address the paucity of information describing the treatable burden of disease associated with severe aortic stenosis (AS) within Australia’s ageing population
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