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The changing course of aortic valve disease in Scotland: hospitalizations, outcomes and temporal trends

Research output: Contribution to journalConference paper

Colin Berry, Suzanne Lloyd, Yanzhong Wang, Alyson MacDonald, Ian Ford

Original languageEnglish
Article numberA16931
JournalCirculation (Baltimore)
Volume124
Issue number21 suppl.
Publication statusPublished - Nov 2011

King's Authors

Abstract

Introduction Aortic valve disease (AVD) is a chronic health problem with a poor prognosis. We hypothesized that the incidence and burden of AVD is increasing. We studied the contemporary course of aortic stenosis (AS), aortic regurgitation (AR) and mixed AVD in Scotland, UK.

Methods Using record linkage with ICD10 codes, we identified all first emergency admissions with a diagnosis of non-congenital AVD in Scotland (popn 5.1 million) from 1 Jan 1997 to 31 Dec 2005 with follow-up to 31 Dec 2006.

Results 20,218 subjects aged ≥18 yrs had an index hospitalization with a final diagnosis of AVD in a primary (n=5341 (26.4%)) or secondary diagnostic position (2nd-6th positions, n=14,877 (73.6% cases)). AS, AR, mixed or unspecified AVD occurred in 13,429 (66.5%), 2,956 (14.6%), 714 (3.5%) and 3,119 (15.4%), individuals, respectively (Fig 1). 10,298 (50.9%) patients had died (all causes) by 31 Dec 2006. Compared to AS, the likelihood of death from any cause was less with AR (Fig 2). In multivariable analyses, female gender, admission year and hypertension reduced the likelihood of death in AS patients. AS increased the risk of death or myocardial infarction, heart failure or stroke/transient ischemic attack. 3,749 (18.5%) patients had a first aortic valve replacement (AVR) of whom 72.7% had AS, 11.9% had an unspecified type of AVD and 10.5% had AR and 4.9% had mixed AVD. The likelihood of AVR increased by admission year in patients with AS and by endocarditis in patients with AR. Age, female gender, and co-morbidity reduced the likelihood of AVR.

Conclusions The hospital burden of AS has substantially increased in Scotland in recent years. AS predicts morbidity and mortality compared to other types of AVD.

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