Undiagnosed Valvular Heart Disease in Older People

Jul 06, 2016
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Authors:
D’Arcy JL, Coffey S, Loudon MA, et al.
Citation:
Large-Scale Community Echocardiographic Screening Reveals a Major Burden of Undiagnosed Valvular Heart Disease in Older People: The OxVALVE Population Cohort Study. Eur Heart J 2016;Jun 26:[Epub ahead of print].
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What are the contemporary clinical and epidemiological characteristics of valvular heart disease (VHD)?

Methods:

The OxVALVE Population Cohort Study (OxVALVE-PCS) is an ongoing prospective cohort study conducted in Oxfordshire, UK. The investigators enrolled 2,500 individuals aged ≥65 years from a primary care population and screened for undiagnosed VHD using transthoracic echocardiography. Participants were stratified by age and gender to explore the prevalence of VHD and examine demographic and clinical characteristics.

Results:

Newly identified (predominantly mild) VHD was detected in 51% of participants. The most common abnormalities were aortic sclerosis (34%), mitral regurgitation (22%), and aortic regurgitation (15%). Aortic stenosis was present in 1.3%. The likelihood of undiagnosed VHD was two-fold higher in the two most deprived socioeconomic quintiles than in the most affluent quintile, and three-fold higher in individuals with atrial fibrillation. Clinically significant (moderate or severe) undiagnosed VHD was identified in 6.4%. In addition, 4.9% of the cohort had pre-existing VHD (a total prevalence of 11.3%). Projecting these findings using population data, the authors estimate that the prevalence of clinically significant VHD will double before 2050.

Conclusions:

The authors concluded that previously undetected VHD affects one in two of the elderly population and is more common in lower socioeconomic classes.

Perspective:

This study reports on the prevalence of undiagnosed and known VHD in older people and the contemporary clinical and epidemiological characteristics of VHD. Previously undetected VHD was detected in just over half of the participants, and prevalence increased linearly with age. These data demonstrate the scale of the emerging epidemic of VHD, with significant implications for clinicians and healthcare policymakers.

Keywords: Aortic Valve Insufficiency, Aortic Valve Stenosis, Atrial Fibrillation, Diagnostic Imaging, Echocardiography, Geriatrics, Heart Valve Diseases, Mitral Valve Insufficiency, Prevalence, Primary Health Care, Primary Prevention, Sclerosis, Socioeconomic Factors


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