Heartbeat: prevalence and treatment of severe aortic stenosis in older patients

Aortic stenosis (AS) is common in the elderly with an increasing number of patients as our population ages but precise estimates of prevalence have been limited by inadequate diagnostic data in most clinical databases. In this issue of Heart , Owens and colleagues1 performed a targeted review of medical records for 5795 participants over age 65 years in the population based Cardiovascular Health Study to determine the frequency of moderate to severe AS. Over 25 years, the cumulative frequency of significant AS was 3.7% with 85% of these patients being hospitalised for severe AS, although only ½ underwent aortic valve replacement. The adjusted incident of significant AS was higher in men, but lower in Blacks, compared with the rest of the study cohort (figure 1). Figure 1 Cumulative incidence plots of AS events and death. Subdistribution and cause-specific AS refer to the plot for each aortic stenosis outcome calculated by subdistribution survival methods and cause specific survival methods, respectively. AS, aortic stenosis. In an editorial, Iung and Arangalage2 point out that this estimate of the community burden of AS is higher than previously reported, which has important implications for healthcare costs, particularly given the evidence that valve replacement is underused …