Contemporary Prevalence of Valvular Heart Disease & Diagnostic Variability Across Centers

BACKGROUND

• Valvular heart disease (VHD) is progressive and deadly, requiring timely diagnosis for optimal outcomes¹
• Prior landmark analyses of VHD prevalence in the United States (US), including the Framingham Heart Study² and Nkomo et al.³ , have reported notable prevalence of disease
  • However, these analyses were limited in scope (e.g., reporting only valvular regurgitation or only aortic and mitral disease, respectively) and sample sizes
• Contemporary prevalence data from larger datasets are needed to better understand the magnitude of the clinical challenge posed by VHD

OBJECTIVE

• To describe the contemporary prevalence of VHD, as well as key trends in prevalence, in a large deidentified dataset with echocardiographic data

METHODS

• Data source: deidentified echocardiographic dataset developed from the CardioCare platform (egnite Database, egnite, Inc., Aliso Viejo, CA, USA) per participating institutional agreements
  • Exemption from Institutional Review Board (IRB) review was obtained for this study from the Western IRB Copernicus Group (Puyallup, WA, US)
• Inclusion criteria:
  • Echocardiographic reports with data on age and sex
  • Presence of ≥1 valid measurement for aortic valve area, jet velocity, mean pressure gradient, and/or other valve findings
  • Echocardiographic procedure dated January 2016 September 2021
  • For a given patient, maximum documented severity per VHD type used for analysis
• Exclusion criteria:
  • Noted prosthetic devices in report(s)
• Occurrence/severity of VHD determined using a clinically reviewed and verified natural language processing algorithm (100% accuracy demonstrated on a sample of 3,000 echocardiographic reports)
  • Disease severity classifications of interest for this analysis: moderate, moderate to severe, severe (i.e., moderate or greater in severity)
  • Mixed VHD defined as the presence of any two of the five VHD types measured

RESULTS

• In total, 714,368 patients (represented by 929,386 echocardiographic reports) included across 35 US community and academic cardiology programs
  • Median recorded age was 67 years, and approximately half of patient population was female
• Observed prevalence of VHD (moderate or greater in severity) was greatest for tricuspid regurgitation (TR , 7.1%), followed by mitral regurgitation (MR, 6.5%), aortic stenosis (AS, 4.1%), aortic regurgitation (AR, 2.3%), and mitral stenosis (MS, 0.5%)
• The prevalence of all VHD types increased with advancing age, with a marked increase beyond 65 years of age
• Mixed VHD prevalence increased with advancing age, with MR/TR most common across all age categories
• VHD overall (of moderate or greater severity) was more common among female patients versus male patients (p < 0.0001)
  • Increases in prevalence of all VHD types (except MS) in both sexes were noted with advancing age

DISCUSSION

• The present study is, to our knowledge, the largest contemporary analysis of VHD prevalence in the US
• Prevalence of VHD continues to be substantial and is more common with advancing age and among female patients
  • Prevalence of mixed VHD, particularly MR/TR, also increases with advancing age, which raises concerns around unrecognized and untreated disease in such patients