title: Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Ruben L J
authors.initials: RL
authors.lastname: Osnabrugge
authors.forename: Darren
authors.initials: D
authors.lastname: Mylotte
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Head
authors.forename: Nicolas M
authors.initials: NM
authors.lastname: Van Mieghem
authors.forename: Vuyisile T
authors.initials: VT
authors.lastname: Nkomo
authors.forename: Corinne M
authors.initials: CM
authors.lastname: LeReun
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
authors.forename: A Pieter
authors.initials: AP
authors.lastname: Kappetein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000453:epidemiology* / Q000601:surgery; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009656:North America / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: AS; CI; SAVR; STS-PROM; TAVR; The Society of Thoracic Surgery Predicted Risk Of Mortality; aortic stenosis; confidence interval; prevalence; surgical aortic valve replacement; transcatheter aortic valve replacement