Disease Prevalence and Number of Candidates for TAVI
Disease Prevalence and Number of Candidates for TAVI
Objectives The purpose of this study was to evaluate the prevalence of aortic stenosis (AS) in the elderly and to estimate the current and future number of candidates for transcatheter aortic valve replacement (TAVR).
Background Severe AS is a major cause of morbidity and mortality in the elderly. A proportion of these patients is at high or prohibitive risk for surgical aortic valve replacement, and is now considered for TAVR.
Methods A systematic search was conducted in multiple databases, and prevalence rates of patients (>75 years) were pooled. A model was based on a second systematic literature search of studies on decision making in AS. Monte Carlo simulations were performed to estimate the number of TAVR candidates in 19 European countries and North America.
Results Data from 7 studies (n = 9,723 subjects) were used. The pooled prevalence of all AS in the elderly was 12.4% (95% confidence interval [CI]: 6.6% to 18.2%), and the prevalence of severe AS was 3.4% (95% CI: 1.1% to 5.7%). Among elderly patients with severe AS, 75.6% (95% CI: 65.8% to 85.4%) were symptomatic, and 40.5% (95% CI: 35.8% to 45.1%) of these patients were not treated surgically. Of those, 40.3% (95% CI: 33.8% to 46.7%) received TAVR. Of the high-risk patients, 5.2% were TAVR candidates. Projections showed that there are approximately 189,836 (95% CI: 80,281 to 347,372) TAVR candidates in the European countries and 102,558 (95% CI: 43,612 to 187,002) in North America. Annually, there are 17,712 (95% CI: 7,590 to 32,691) new TAVR candidates in the European countries and 9,189 (95% CI: 3,898 to 16,682) in North America.
Conclusions With a pooled prevalence of 3.4%, the burden of disease among the elderly due to severe AS is substantial. Under the current indications, approximately 290,000 elderly patients with severe AS are TAVR candidates. Nearly 27,000 patients become eligible for TAVR annually.
Aortic stenosis (AS) is the most common valvular heart disease in developed countries, and its impact on public health and health care resources is expected to increase due to aging Western populations. Each year, approximately 67,500 surgical aortic valve replacements (SAVR) are performed in the United States. Studies describing the prevalence of AS are scarce and report disparate results (3% to 23%), and currently there is no systematic overview of population-based studies that have assessed the prevalence of AS.
The emergence of transcatheter aortic valve replacement (TAVR) has renewed interest in the epidemiology of AS. In particular, these data may be important to predict the number of TAVR candidates, service development, financial planning, and physician training. In addition, estimates of potential TAVR candidates at intermediate and low surgical risk are not available. Several factors must be considered when estimating the number of TAVR candidates: the percentage of patients with severe AS who are symptomatic; the proportion of patients with symptomatic severe AS who do not undergo SAVR and could thus be considered TAVR candidates; and the percentage of those patients referred for TAVR who actually receive a transcatheter valve.
Therefore, we sought to assess the prevalence of AS in the general elderly population (age ≥75 years) through a systematic review and meta-analysis of population-based studies. The second objective was to systematically estimate the number of elderly patients who are TAVR candidates in both the European countries and North America.
Abstract and Introduction
Abstract
Objectives The purpose of this study was to evaluate the prevalence of aortic stenosis (AS) in the elderly and to estimate the current and future number of candidates for transcatheter aortic valve replacement (TAVR).
Background Severe AS is a major cause of morbidity and mortality in the elderly. A proportion of these patients is at high or prohibitive risk for surgical aortic valve replacement, and is now considered for TAVR.
Methods A systematic search was conducted in multiple databases, and prevalence rates of patients (>75 years) were pooled. A model was based on a second systematic literature search of studies on decision making in AS. Monte Carlo simulations were performed to estimate the number of TAVR candidates in 19 European countries and North America.
Results Data from 7 studies (n = 9,723 subjects) were used. The pooled prevalence of all AS in the elderly was 12.4% (95% confidence interval [CI]: 6.6% to 18.2%), and the prevalence of severe AS was 3.4% (95% CI: 1.1% to 5.7%). Among elderly patients with severe AS, 75.6% (95% CI: 65.8% to 85.4%) were symptomatic, and 40.5% (95% CI: 35.8% to 45.1%) of these patients were not treated surgically. Of those, 40.3% (95% CI: 33.8% to 46.7%) received TAVR. Of the high-risk patients, 5.2% were TAVR candidates. Projections showed that there are approximately 189,836 (95% CI: 80,281 to 347,372) TAVR candidates in the European countries and 102,558 (95% CI: 43,612 to 187,002) in North America. Annually, there are 17,712 (95% CI: 7,590 to 32,691) new TAVR candidates in the European countries and 9,189 (95% CI: 3,898 to 16,682) in North America.
Conclusions With a pooled prevalence of 3.4%, the burden of disease among the elderly due to severe AS is substantial. Under the current indications, approximately 290,000 elderly patients with severe AS are TAVR candidates. Nearly 27,000 patients become eligible for TAVR annually.
Introduction
Aortic stenosis (AS) is the most common valvular heart disease in developed countries, and its impact on public health and health care resources is expected to increase due to aging Western populations. Each year, approximately 67,500 surgical aortic valve replacements (SAVR) are performed in the United States. Studies describing the prevalence of AS are scarce and report disparate results (3% to 23%), and currently there is no systematic overview of population-based studies that have assessed the prevalence of AS.
The emergence of transcatheter aortic valve replacement (TAVR) has renewed interest in the epidemiology of AS. In particular, these data may be important to predict the number of TAVR candidates, service development, financial planning, and physician training. In addition, estimates of potential TAVR candidates at intermediate and low surgical risk are not available. Several factors must be considered when estimating the number of TAVR candidates: the percentage of patients with severe AS who are symptomatic; the proportion of patients with symptomatic severe AS who do not undergo SAVR and could thus be considered TAVR candidates; and the percentage of those patients referred for TAVR who actually receive a transcatheter valve.
Therefore, we sought to assess the prevalence of AS in the general elderly population (age ≥75 years) through a systematic review and meta-analysis of population-based studies. The second objective was to systematically estimate the number of elderly patients who are TAVR candidates in both the European countries and North America.
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