Distribution, Characteristics, and Management of Older Patients With Valvular Heart Disease in China
Haiyan Xu, Qing‐Rong Liu, Kai Cao, Yunqing Ye, Bin Zhang, Zhe Li, Jie Hao, Xiling Qi, Qinghao Zhao, Sisi Liu, Runlin Gao, Yongjian Wu
Abstract
The epidemiology and management of valvular heart disease (VHD) have changed with economic development and population aging in China in recent decades. This study sought to understand the distribution, etiology, and presentation and assess the current practice and outcomes of older patients with VHD in China. The authors conducted the first nationwide survey of older patients with VHD between September and December 2016 from 69 hospitals in 28 provinces and municipalities throughout China. Hospitalized patients over 60 years of age with moderate-to-severe VHD, infective endocarditis, or previous valvular intervention were consecutively enrolled. Of 8,929 patients (median age of 69 years, 47.5% female), 8227 (92.1%) had native VHD. Mitral regurgitation was the most prevalent single VHD (26.9% of native VHD), followed by tricuspid regurgitation (16.5%), aortic regurgitation (10.6%), aortic stenosis (5.1%), and mitral stenosis (3.1%). Degenerative (37.2%), functional (21.8%), and rheumatic (15.0%) etiologies were the 3 most common causes. Among symptomatic patients with severe VHD, 37.3% underwent valvular intervention. The intervention rates decreased significantly with age across all types of VHD (Ptrend < 0.01). Valvular surgery covered 93.7% of interventions. The overall 1-year survival rate was 74.4% (95% CI: 63.4%-85.4%). This study provides a unique national insight into the contemporary spectrum and management of older VHD patients in China. With the increase in the health care demand, more resources and efforts are required for early detection, effective intervention, and targeting innovation on advanced therapeutic techniques and devices to improve the outcomes.