Clinical InvestigationAortic StenosisRisk for Mortality with Increasingly Severe Aortic Stenosis: An International Cohort Study
Section snippets
Study Design
We conducted a multicenter, international, parallel-group, observational cohort study with individually linked long-term follow-up outcomes data, adhering to the Reporting of Studies Conducted Using Observational Routinely Collected Health Data statement for the conduct and reporting of observational studies.19 Two matching real-world, clinical cohorts comprising patients undergoing routine echocardiography were studied, National Echo Database Australia and the Medicare-linked Electronic
Study Cohorts
As shown in Figure 1, individually linked mortality data were available for 211,635 Australian and 30,810 US patients aged ≥65 years with Vmax levels determined by echocardiography. A total of 1,081 US individuals (1.6%) and 18,405 Australian individuals (2.9%) were excluded from the analysis because of prior AVR. Of those not excluded on the basis of AVR at baseline, a total of 393 individuals (0.9%) in the US cohort and 5,454 (1.1%) in the Australian cohort underwent AVR during follow-up (of
Discussion
In a combined analysis of nearly 250,000 patients from two different continents (and health systems), we found a consistent pattern of increased risk for mortality associated with increasing peak aortic valve velocity, indicative of progressively worsening AS. Specifically, we found that after adjusting for potentially important clinical confounders and contributors to excess mortality, an inflection point for increased mortality in patients presenting with less severe forms of AS (compared
Conclusion
In a large, parallel-group, international cohort study, we observed a consistent pattern of increasing mortality associated with increasing AS severity. The risk for mortality linearly increased above a Vmax of 2.0 to 3.0 m/sec and plateaued above a Vmax of 3.0 m/sec. This pattern persisted despite detailed adjustment for clinical comorbidities, including coronary artery disease, cancer, and dementia, pharmacologic treatments, and prior revascularization. Overall, these findings support ongoing
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This study was supported by an investigator-initiated grant from Edwards Lifesciences (with no input or influence on the interpretation of study data or this report). Dr. Strom additionally reports support from the National, Heart, Lung, and Blood Institute (grant 1K23HL144907).
Dr. Stewart is supported by the National Health and Medical Research Council of Australia (grant GNT1135894). Dr. Strom is supported by grants from the National Heart, Lung, and Blood Institute (grant 1K23HL144907), Anumana, HeartSciences, and Ultromics. Drs. Strange and Playford are the co–principal investigators and directors of National Echo Database Australia (a not-for-profit research entity), which has received investigator-initiated funding support from Novartis Pharmaceuticals and Edward Lifesciences in the past 3 years. Dr. Stewart has received consultancy fees from National Echo Database Australia. Drs. Stewart, Playford, and Strange have previously received consultancy and speaking fees from Edwards Lifesciences. Dr. Strom is a member of the scientific advisory board for Edwards Lifesciences, is a consultant for Bracco Diagnostics and General Electric Healthcare, and has received speaker fees from Northwest Imaging Forums, unrelated to the submitted work.