Valvular & structural heart diseaseCohort study
Severe aortic stenosis: secular trends of incidence and outcomes
- Population-based cohort study
- community-based
- 20-year period
Authors' conclusion
Over 20 years, the population incidence of severe AS remained stable with increased absolute case burden related to population growth. Despite stable severe AS presentation, AVR performance grew notably, but while declining, undertreatment remained substantial and disease lethality did not yet decline.
Study context
- Population
- Adult residents of Olmsted County (MN, US) with incident severe aortic stenosis (AS) defined by quantitative Doppler echocardiography, 1997–2016incident severe AS
- Participants
- 1,069 residents
- Exposure
- Males vs Females
- Outcome
- Trends in incidence of severe AS
- Follow-up
- 1997-2016
Main finding
As reported in the abstract
Incidence of severe AS
- men · incidence trend stable in men
- IRR 0.99; P = 0.7
- women · incidence trend declining in women
- IRR 0.93; P = 0.02
- Incidence rate, per 100 000 patient-year
- 52.5 [49.4-55.8]
- Age- and sex-adjusted incidence (US population), per 100 000 residents/year
- 53.8 [50.6-57.0]
- Incidence stable over 20 years
- P = 0.2
- Absolute burden of incident cases markedly increased (population growth)
- P = 0.0004
Observational data: associations, not effects.
Further findings
Survival with early aortic valve replacement (AVR)
| Comparison | adjusted HR (CI) | P value | |
|---|---|---|---|
| Early AVR | 0.55 (0.42–0.71) | P < 0.0001 | |
| 0.512Adjusted hazard ratio (log scale) |
Time to AVR
- 1997-2000
- 1.3 [0.1-3.3] years
- 2013-16
- 0.5 [0.2-2.1] years
- Trend
- P = 0.001
- Undertreatment
- >40%
Overall mortality
- 3-month mortality
- 8%
- 3-year mortality
- 36%
- Unchanged throughout the study
- all P ≥ .4
Original publication
Severe aortic stenosis: secular trends of incidence and outcomes. Eur Heart J. Published 8 January 2024. doi:10.1093/eurheartj/ehad887
Summarised from the published abstract; every number is checked against it