Prevalence, referral patterns, testing, and surgery in aortic valve disease: leaving women and elderly patients behind?
OBJECTIVE
The prevalence of aortic valve disease is not well defined, and it is not known to what degree gender and age affect testing and surgery for this condition. The study aim was to describe the prevalence of aortic valve disease in the United States population by extrapolating from administrative claims databases; and to investigate differences associated with gender and age in referral, diagnostic testing, and aortic valve replacement (AVR).


METHODS
A claims database of approximately five million privately insured beneficiaries and a 5% sample of Medicare beneficiaries were queried for patients with aortic valve disease. Prevalence was calculated by age group and gender, and extrapolated to the 2005 US population. The proportion of patients with a cardiologist or cardiovascular surgeon visit, performance of echocardiography or stress testing, and AVR within a year of diagnosis was determined.


RESULTS
The extrapolated prevalence of aortic valve disease in the US in 2005 was 1.8% (approximately 5.2 million people); in persons aged > or =65 years, prevalence was 10.7%. Women were seen by a specialist, underwent diagnostic tests and underwent AVR at rates significantly lower than men, as did patients aged > or =80 years compared to those aged 65-79 years. AVR was performed at approximately half the rate in women (1.4%) compared to men (2.7%, p <0.001), and in patients aged > or =80 years (1.1%) compared to those aged 65-79 years (2.5%, p <0.001).


CONCLUSIONS
In 2005, approximately 5.2 million adults in the US were estimated to have a diagnosis of aortic valve disease. Advanced age and female gender were associated with lower rates of specialist visits, diagnostic testing, and AVR.
Bach
David S
DS
Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI 48109, USA. dbach@umich.edu
Radeva
Jasmina I
JI
Birnbaum
Howard G
HG
Fournier
Andrée-Anne
AA
Tuttle
Edward G
EG
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001021:Aortic Valve; D002648:Child; D002675:Child, Preschool; D003935:Diagnostic Techniques, Cardiovascular / Q000706:statistics & numerical data; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology