Temporal trends in the prevalence and severity of aortic stenosis within a contemporary and diverse community-based cohort

Highlights

• The prevalence of aortic stenosis has grown substantially.

• The prevalence of aortic stenosis is lower for Asian/Pacific Islanders.

• The distribution of aortic stenosis severity has not changed over time.

Abstract

Background

Data on the epidemiology of aortic stenosis (AS) are primarily derived from single center experiences and administrative claims data that do not delineate by degree of disease severity.

Methods

An observational cohort study of adults with echocardiographic AS was conducted January 1st, 2013-December 31st, 2019 at an integrated health system. The presence/grade of AS was based on physician interpretation of echocardiograms.

Results

A total of 66,992 echocardiogram reports for 37,228 individuals were identified. The mean ± standard deviation (SD) age was 77.5 ± 10.5, 50.5% (N = 18,816) were women, and 67.2% (N = 25,016) were non-Hispanic whites. The age-standardized AS prevalence increased from 589 (95% Confidence Interval [CI] 580–598) to 754 (95% CI 744–764) cases per 100,000 during the study period. The age-standardized AS prevalences were similar in magnitude among non-Hispanic whites (820, 95% CI 806–834), non-Hispanic blacks (728, 95% CI 687–769), and Hispanics (789, 95% CI 759–819) and substantially lower for Asian/Pacific Islanders (511, 95% CI 489–533). Finally, the distribution of AS by degree of severity remained relatively unchanged over time.

Conclusions and relevance

The population prevalence of AS has grown considerably over a short timeframe although the distribution of AS severity has remained stable.

Introduction

The prevalence of aortic stenosis (AS) has been estimated to be ∼4% among adults aged ≥70 years and projected to double by 2040 and triple by 2060 [1,2]. However, the systematic evaluation of valvular heart disease has previously been limited by reliance on administrative claims data, which inherently lack sensitivity and do not explicitly delineate the degree of severity [3]. Furthermore, the contemporary epidemiology of AS has not been well-characterized in a demographically diverse, community-based population [4]. Thus, we aimed to leverage state-of-the-art electronic health record (EHR) data to describe temporal trends in the prevalence and severity of AS by age, gender, and race/ethnicity within an integrated health care delivery system.