Rate of aortic valve replacement for elderly patients has increased; outcomes improved
Jose Augusto Barreto-Filho, M.D., Ph.D., of the Federal University of Sergipe and the Clinica e Hospital Sao Lucas, Sergipe, Brazil, and colleagues assessed procedure rates and outcomes of surgical aortic valve replacement (AVR) among 82,755,924 Medicare fee-for-service beneficiaries between 1999 and 2011.
“Aortic valve disease in the United States is a major cardiovascular problem that is likely to grow as the population ages. Aortic valve replacement is the standard treatment even for very elderly patients despite its risks in this age group. With transcatheter aortic valve replacement emerging as a less invasive option, contemporary data from real-world practice are needed to provide a perspective on the outcomes that are being achieved with surgery,” according to background information in the article.
The primary measured outcomes for the study were procedure rates for surgical AVR alone and with coronary artery bypass graft (CABG) surgery, 30-day and 1-year mortality, and 30-day readmission rates.
The researchers found that rates of AVR increased between 1999 and 2011, including AVR without CABG surgery, while the rate of AVR with CABG surgery decreased during this time period. Procedure rates increased in all age, sex, and race strata, most notably in patients 75 years or older.
Mortality decreased at 30 days (absolute decrease, 3.4 percent; adjusted annual decrease, 4.1 percent) per year and at 1 year (absolute decrease, 2.6 percent; adjusted annual decrease, 2.5 percent). Thirty-day all-cause readmission also decreased by 1.1 percent per year. In addition, AVR with CABG surgery decreased and women and black patients had lower procedure and higher mortality rates.
U.S. Aortic Stenosis Disease Prevalence & Treatment Statistics
“These findings may provide a useful benchmark for outcomes of aortic valve replacement surgery for older patients eligible for surgery considering newer transcatheter treatments,” the authors write.
Cardiovascular disease is the number one cause of death, killing more than 600,000 Americans each year.
According to the American Heart Association, more than five million Americans are diagnosed with heart valve disease each year.
Heart valve disease can occur in any single valve or a combination of the four valves, but diseases of the aortic and mitral valves are the most common, affecting more than five percent of the population.
While up to 1.5 million people in the U.S. suffer from aortic stenosis (AS), approximately 500,000 within this group of patients suffer from severe AS. An estimated 250,000 patients with severe AS are symptomatic.
An echocardiogram is the primary imaging test used to diagnose severe AS.
Without an aortic valve replacement (AVR), 50 percent of patients will not survive more than an average of two years after the onset of symptoms.
The predicted survival of inoperable patients with severe AS who are treated with standard non-surgical therapy is lower than with certain metastatic cancers.
Studies show that severe AS is undertreated. At many hospitals, more than 50 percent of patients that receive an echo and show the presence of the disease are not referred to a surgeon to be evaluated for an AVR. The
absence of chest pain symptoms and overestimating risks associated with the AVR procedure have been identified as some of the reasons lack of patient referrals occur.
An estimated 85,000 AVR procedures are performed every year in the U.S.
Source: U.S. Aortic Stenosis Disease Prevalence & Treatment Statistics | University of Maryland Medical Center
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(doi:10.l001/jama.2013.282437; Available pre-embargo to the media at http://media.jamanetwork.com)
Media Advisory: To contact corresponding author Harlan M. Krumholz, M.D., S.M., call Karen N. Peart at 203-980-2222 or email .(JavaScript must be enabled to view this email address).