Temporal Trends in Disease Severity and Predicted Surgical Risk at the Time of Referral for Echocardiography in Patients Diagnosed with Aortic Stenosis
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Temporal Trends in Disease Severity and Predicted Surgical Risk at the Time of Referral for Echocardiography in Patients Diagnosed with Aortic Stenosis. / Ersboll, Mads; Samad, Zainab; Al Enezi, Fawaz; Kisslo, Joseph; Schulte, Phillip J.; Shaw, Linda K.; Køber, Lars; Harrison, J. Kevin; Bashore, Thomas; Brennan, Matthew; Velazquez, Eric J.
In: Critical Pathways in Cardiology, Vol. 14, No. 3, 09.2015, p. 103-109.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Temporal Trends in Disease Severity and Predicted Surgical Risk at the Time of Referral for Echocardiography in Patients Diagnosed with Aortic Stenosis
AU - Ersboll, Mads
AU - Samad, Zainab
AU - Al Enezi, Fawaz
AU - Kisslo, Joseph
AU - Schulte, Phillip J.
AU - Shaw, Linda K.
AU - Køber, Lars
AU - Harrison, J. Kevin
AU - Bashore, Thomas
AU - Brennan, Matthew
AU - Velazquez, Eric J.
PY - 2015/9
Y1 - 2015/9
N2 - BACKGROUND: Calcific aortic stenosis (AS) is the most common underlying pathology in patients undergoing heart valve surgery, with an expected increasing prevalence among the aging population.METHODS AND RESULTS: We identified the temporal trends in referral patterns, disease severity, and associated surgical risk among patients with AS between January 1, 1995 and December 31, 2012 at the Duke University Hospital. A total of 6103 patients had a finding of mild (n = 3303), moderate (n = 1648), or severe AS (n = 1152) in a native aortic valve. Overall presence of severe AS increased significantly over time (P = 0.009) with the most substantial increase occurring from 2010 and onward. Median age upon referral (P < 0.001) and attendant predicted surgical risk (P < 0.001) increased significantly in the observation period among patients with a finding of severe AS. Among patients with a finding of severe AS, the proportion of patients aged older than 80 years increased to 51.0% in the most recent time period (2010-2012) compared with 32.6% in the preceding time period (P < 0.001 for overall time trend). Similarly, the proportion of patients with a logistic EuroSCORE greater than 20% increased to 21.3% (2010-2012) from 12.1% (pre-2010).CONCLUSIONS: Among patients referred for echocardiography to a high-volume tertiary hospital center, a significant increase in the prevalence of severe AS was observed over time. This trend occurred in parallel with increasing age and predicted surgical risk at referral. Health-care resource planning should account for an increasing number of patients in need of high-risk aortic valve replacements in the near future.
AB - BACKGROUND: Calcific aortic stenosis (AS) is the most common underlying pathology in patients undergoing heart valve surgery, with an expected increasing prevalence among the aging population.METHODS AND RESULTS: We identified the temporal trends in referral patterns, disease severity, and associated surgical risk among patients with AS between January 1, 1995 and December 31, 2012 at the Duke University Hospital. A total of 6103 patients had a finding of mild (n = 3303), moderate (n = 1648), or severe AS (n = 1152) in a native aortic valve. Overall presence of severe AS increased significantly over time (P = 0.009) with the most substantial increase occurring from 2010 and onward. Median age upon referral (P < 0.001) and attendant predicted surgical risk (P < 0.001) increased significantly in the observation period among patients with a finding of severe AS. Among patients with a finding of severe AS, the proportion of patients aged older than 80 years increased to 51.0% in the most recent time period (2010-2012) compared with 32.6% in the preceding time period (P < 0.001 for overall time trend). Similarly, the proportion of patients with a logistic EuroSCORE greater than 20% increased to 21.3% (2010-2012) from 12.1% (pre-2010).CONCLUSIONS: Among patients referred for echocardiography to a high-volume tertiary hospital center, a significant increase in the prevalence of severe AS was observed over time. This trend occurred in parallel with increasing age and predicted surgical risk at referral. Health-care resource planning should account for an increasing number of patients in need of high-risk aortic valve replacements in the near future.
KW - Aged
KW - Aged, 80 and over
KW - Aortic Valve
KW - Aortic Valve Stenosis
KW - Calcinosis
KW - Cohort Studies
KW - Echocardiography
KW - Female
KW - Hospitals, High-Volume
KW - Humans
KW - Male
KW - Middle Aged
KW - Patient Selection
KW - Referral and Consultation
KW - Risk Assessment
KW - Severity of Illness Index
KW - Tertiary Care Centers
KW - Time Factors
U2 - 10.1097/HPC.0000000000000048
DO - 10.1097/HPC.0000000000000048
M3 - Journal article
C2 - 26214813
VL - 14
SP - 103
EP - 109
JO - Critical Pathways in Cardiology
JF - Critical Pathways in Cardiology
SN - 1535-282X
IS - 3
ER -
ID: 162758083