Structural Heart

Older Patients and Asymptomatic Valvular Heart Disease

A new study out of the UK found that over a quarter of people aged 60+ have asymptomatic valvular heart disease, and revealed that prevalence increases as patients age — potentially providing new reasons to screen older patients for VHD.

  • VHD diagnosis generally involves echo exams, ordered in response to patient symptoms or abnormal cardiac auscultation.
  • However, this practice leaves many older patients with undetected VHD, raising interest in using echocardiography as a large-scale VHD screening tool.

To test that theory, researchers performed echo exams on 4,237 asymptomatic 60-and-over adults between 2007 and 2016, finding that…

  • A whopping 28.2% of participants had VHD
  • 2.4% of the VHD cases were clinically significant, including 94 moderate cases and 7 severe cases.
  • Significant VHD prevalence increased with age: 1.5% at 60-64yrs, 2.1% at 70-74yrs, 3.8% at 75-79yrs, and 10% at 85+.
  • The most common VHD cases were tricuspid (13.8%), mitral (12.8%), and aortic (8.3%) regurgitation.

Perhaps most actionable, age was the only factor associated with severe VHD (odds ratio: 1.07 per year), with the number of echo scans required to diagnose one clinically significant VHD case falling from 42 scans among 60-74yr olds to 15 scans among 75-and-over patients. 

Age-targeted VHD echo screening might result in even more positive cases in the real world, noting that only 8.6% of this study’s population was ≥80 years old, and other studies have found 51% prevalence of any VHD among over-65 patients and 17% prevalence of moderate-to-severe VHD among 80-and-over patients.

The Takeaway

By 2050 the over-60 population is expected to double, while the over-80 population triples. That elderly population surge will apparently come with a similar surge in undiagnosed VHD cases, unless there’s big changes to how we screen for VHD.

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