Management of aortic stenosis in Sweden from 2005 to 2021 showed an increased incidence and a shift towards TAVI (from 12.9% in 2010 to 57.2% in 2021), alongside improved 1-year mortality rates.
Observational (n=85,359)
Yes
What are the temporal trends in incidence, interventions, outcomes, and costs for patients diagnosed with aortic stenosis in Sweden between 2005 and 2021?
This nationwide Swedish study demonstrates a significant shift toward TAVI for aortic stenosis management, accompanied by improved mortality rates, shorter hospital stays, and increased overall healthcare costs.
Abstract Introduction Over the latest decades, the introduction of transcatheter aortic valve implantation (TAVI) has transformed management of aortic stenosis (AS). As a consequence, temporal trends in contemporary management of AS is of interest. Purpose To investigate temporal trends in incidence, patient characteristics, interventions and health care related costs in patients diagnosed with AS. Methods The Swedish national patient registry, merged with SWEDEHEART was used to identify all Swedish patients with an ICD-10 diagnosis of AS, defined as either I350 or I352 and all interventions due to AS between 2005 and 2021. Data from the cost per patient database was used to identify costs associated with specific diagnoses and interventions. Results A total of 85,359 patients were identified. From 2005 to 2020 the incidence of AS increased from 45 to 55 new annual cases per 100.000 inhabitants. The number of interventions increased due to an increased number of TAVI while isolated surgical aortic valve replacement (SAVR) remained fairly constant. For 2021, the incidence rates dropped, likely due to the pandemic. For all patients diagnosed with AS, both 30 day and 1 year mortality rates from first hospitalization due to AS remained constant over time (~7% and ~22% respectively) whilst cardiovascular mortality rates decreased (4.6-3.6% and 15.4-10.3% respectively). For TAVI, 30-day and 1 year mortality rates improved over time and went from 2.6-1.4% and 15.7-7.3% respectively. For SAVR, the corresponding rates were 1.9-0.6% and 4.7-1.7% (Figure 1). Between 2013 and 2021, the total annual cost associated with hospitalizations for AS increased by an average of 3.7% per year (after adjustment for increase in the healthcare price level) to 844 million Swedish Krona (MSEK, current prices) in 2021. For TAVI, the costs associated with the procedure itself decreased over time by 4.6% per year. However, due to an increased number of interventions, the annual cost increased by 17.2% per year to 410 MSEK in 2021. The cost for SAVR remained constant around 200 MSEK per year (Figure 2). Over time, the mean age for first diagnosis of AS remained unchanged (77 years) whilst the proportion of men increased to 58.3 percent in 2021. The proportion of TAVI interventions increased from 12.9 % in 2010 to 57.2% in 2021 . For TAVI, mean length of stay went from 8.1 days to 3.2 days. The corresponding rates for SAVR were 8.5 to 5.8 days. New onset permanent pacemaker went from 13.2 to 6.6% for TAVI patients. Conclusion This Swedish nationwide study presents the effect of recent advances in the treatment of aortic stenosis in terms of an increase in new diagnoses of AS, a clear shift towards TAVI and increased costs related to contemporary AS care.Trends in all-cause mortality Trends in costs for aortic stenosis care
Nilsson et al. (2025) conducted an observational in Aortic stenosis (n=85,359). Transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) was evaluated on Temporal trends in incidence, patient characteristics, interventions and health care related costs. Management of aortic stenosis in Sweden from 2005 to 2021 showed an increased incidence and a shift towards TAVI (from 12.9% in 2010 to 57.2% in 2021), alongside improved 1-year mortality rates.