The following is a summary of “Severe aortic stenosis: secular trends of incidence and outcomes,” published in the June 2024 issue of Cardiology by Benfari et al.
Researchers conducted a retrospective study tracking and analyzing changes in incidence, clinical presentation, treatment, and outcomes for severe aortic stenosis (AS) in a population-based community over the last two decades.
They counted all adults in Olmsted County, MN diagnosed with severe AS between 1997-2016 using strict criteria (aortic valve area ≤1 cm2, aortic valve area index ≤0.6 cm2/m2, mean gradient ≥40 mm Hg, peak velocity ≥4 m/s, Doppler velocity index ≤0.25) to track trends in incidence, symptoms, treatment, and outcomes.
The results showed that severe AS was diagnosed in 1,069 residents, with an incidence rate of 52.5 (49.4-55.8) per 100,000 patient-years. The incidence rate was almost unchanged after adjusting for age and sex 53.8 [50.6-57.0] per 100,000 residents/year. The incidence rates were stable for over 20 years (P=0.2) but increased with more cases due to population growth (P=0.0004). Incidence remained steady in men (incidence rate ratio: 0.99; P=0.7) but dropped in women (incidence rate ratio: 0.93, P=0.02). During the investigation, aortic valve replacement (AVR) increased and was quicker (from 1.3 [0.1-3.3] years in 1997-2000 to 0.5 [0.2-2.1] years in 2013-2016; P=0.001), yet undertreatment persisted (>40%). Early AvR improved survival (HR, 0.55, [0.42-0.71], P<0.0001). Mortality remained high (3-month 8%, 3-year 36%) and unchanged (all P≥0.4).
Investigators concluded that while severe AS incidence stayed stable, population growth increased cases, AVR procedures improved but undertreatment and high mortality persisted.
Source: academic.oup.com/eurheartj/article-abstract/45/21/1877/7512981
