Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA.
Department of Biostatistics, University of Washington, Seattle, Washington, USA.
Heart. 2021 Sep;107(18):1493-1502. doi: 10.1136/heartjnl-2021-319025. Epub 2021 Jun 2.
Current estimates of aortic stenosis (AS) frequency have mostly relied on cross-sectional echocardiographic or longitudinal administrative data, making understanding of AS burden incomplete. We performed case adjudications to evaluate the frequency of AS and assess differences by age, sex and race in an older cohort with long-term follow-up.
We developed case-capture methods using study echocardiograms, procedure and diagnosis codes, heart failure events and deaths for targeted review of medical records in the Cardiovascular Health Study to identify moderate or severe AS and related procedures or hospitalisations. The primary outcome was clinically significant AS (severe AS or procedure). Assessment of incident AS burden was based on subdistribution survival methods, while associations with age, sex and race relied on cause-specific survival methods.
The cohort comprised 5795 participants (age 73±6, 42.2% male, 14.3% Black). Cumulative frequency of clinically significant AS at maximal 25-year follow-up was 3.69% (probable/definite) to 4.67% (possible/probable/definite), while the corresponding 20-year cumulative incidence was 2.88% to 3.71%. Of incident cases, about 85% had a hospitalisation for severe AS, but roughly half did not undergo valve intervention. The adjusted incidence of clinically significant AS was higher in men (HR 1.62 [95% CI 1.21 to 2.17]) and increased with age (HR 1.08 [95% CI 1.04 to 1.11]), but was lower in Blacks (HR 0.43 [95% CI 0.23 to 0.81]).
In this community-based study, we identified a higher burden of clinically significant AS than reported previously, with differences by age, sex and race. These findings have important implications for public health resource planning, although the lower burden in Blacks merits further study.
目前对主动脉瓣狭窄（AS）频率的估计主要依赖于横断面超声心动图或纵向行政数据，因此对 AS 负担的了解并不完整。我们进行了病例裁决，以评估在具有长期随访的老年队列中 AS 的频率，并评估年龄、性别和种族的差异。
我们使用研究超声心动图、程序和诊断代码、心力衰竭事件和死亡，开发了病例捕获方法，对心血管健康研究中的医疗记录进行有针对性的审查，以识别中度或重度 AS 以及相关程序或住院治疗。主要结局是临床显著的 AS（严重 AS 或程序）。基于亚分布生存方法评估新发 AS 负担，而与年龄、性别和种族的关联则依赖于特定原因的生存方法。
该队列包括 5795 名参与者（年龄 73±6 岁，42.2%为男性，14.3%为黑人）。在最大 25 年的随访中，临床显著 AS 的累积频率为 3.69%（可能/确定）至 4.67%（可能/可能/确定），而相应的 20 年累积发病率为 2.88%至 3.71%。在新发病例中，约 85%的人因严重 AS 住院，但大约一半的人没有接受瓣膜介入治疗。男性（HR 1.62[95%CI 1.21 至 2.17]）和年龄增加（HR 1.08[95%CI 1.04 至 1.11]）的临床显著 AS 调整发病率较高，但黑人（HR 0.43[95%CI 0.23 至 0.81]）的发病率较低。
在这项基于社区的研究中，我们发现临床显著 AS 的负担高于之前报道的，且存在年龄、性别和种族差异。这些发现对公共卫生资源规划具有重要意义，尽管黑人的负担较低值得进一步研究。
