Temporal Trends in Disease Severity and Predicted Surgical Risk at the Time of Referral for Echocardiography in Patients Diagnosed with Aortic Stenosis

TY - JOUR

T1 - Temporal Trends in Disease Severity and Predicted Surgical Risk at the Time of Referral for Echocardiography in Patients Diagnosed with Aortic Stenosis

AU - Ersboll, Mads

AU - Samad, Zainab

AU - Al Enezi, Fawaz

AU - Kisslo, Joseph

AU - Schulte, Phillip J.

AU - Shaw, Linda K.

AU - Køber, Lars

AU - Harrison, J. Kevin

AU - Bashore, Thomas

AU - Brennan, Matthew

AU - Velazquez, Eric J.

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Background: Calcific aortic stenosis (AS) is the most common underlying pathology in patients undergoing heart valve surgery, with an expected increasing prevalence among the aging population. Methods and Results: We identified the temporal trends in referral patterns, disease severity, and associated surgical risk among patients with AS between January 1, 1995 and December 31, 2012 at the Duke University Hospital. A total of 6103 patients had a finding of mild (n = 3303), moderate (n = 1648), or severe AS (n = 1152) in a native aortic valve. Overall presence of severe AS increased significantly over time (P = 0.009) with the most substantial increase occurring from 2010 and onward. Median age upon referral (P < 0.001) and attendant predicted surgical risk (P < 0.001) increased significantly in the observation period among patients with a finding of severe AS. Among patients with a finding of severe AS, the proportion of patients aged older than 80 years increased to 51.0% in the most recent time period (2010-2012) compared with 32.6% in the preceding time period (P < 0.001 for overall time trend). Similarly, the proportion of patients with a logistic EuroSCORE greater than 20% increased to 21.3% (2010-2012) from 12.1% (pre-2010). Conclusions: Among patients referred for echocardiography to a high-volume tertiary hospital center, a significant increase in the prevalence of severe AS was observed over time. This trend occurred in parallel with increasing age and predicted surgical risk at referral. Health-care resource planning should account for an increasing number of patients in need of high-risk aortic valve replacements in the near future.

AB - Background: Calcific aortic stenosis (AS) is the most common underlying pathology in patients undergoing heart valve surgery, with an expected increasing prevalence among the aging population. Methods and Results: We identified the temporal trends in referral patterns, disease severity, and associated surgical risk among patients with AS between January 1, 1995 and December 31, 2012 at the Duke University Hospital. A total of 6103 patients had a finding of mild (n = 3303), moderate (n = 1648), or severe AS (n = 1152) in a native aortic valve. Overall presence of severe AS increased significantly over time (P = 0.009) with the most substantial increase occurring from 2010 and onward. Median age upon referral (P < 0.001) and attendant predicted surgical risk (P < 0.001) increased significantly in the observation period among patients with a finding of severe AS. Among patients with a finding of severe AS, the proportion of patients aged older than 80 years increased to 51.0% in the most recent time period (2010-2012) compared with 32.6% in the preceding time period (P < 0.001 for overall time trend). Similarly, the proportion of patients with a logistic EuroSCORE greater than 20% increased to 21.3% (2010-2012) from 12.1% (pre-2010). Conclusions: Among patients referred for echocardiography to a high-volume tertiary hospital center, a significant increase in the prevalence of severe AS was observed over time. This trend occurred in parallel with increasing age and predicted surgical risk at referral. Health-care resource planning should account for an increasing number of patients in need of high-risk aortic valve replacements in the near future.

KW - Aged

KW - Aged, 80 and over

KW - Aortic Valve

KW - Aortic Valve Stenosis

KW - Calcinosis

KW - Cohort Studies

KW - Echocardiography

KW - Female

KW - Hospitals, High-Volume

KW - Humans

KW - Male

KW - Middle Aged

KW - Patient Selection

KW - Referral and Consultation

KW - Risk Assessment

KW - Severity of Illness Index

KW - Tertiary Care Centers

KW - Time Factors

U2 - 10.1097/HPC.0000000000000048

DO - 10.1097/HPC.0000000000000048

M3 - Journal article

C2 - 26214813

SN - 1535-282X

VL - 14

SP - 103

EP - 109

JO - Critical Pathways in Cardiology

JF - Critical Pathways in Cardiology

IS - 3

ER -