title: Lack of progress in valvular heart disease in the pre-transcatheter aortic valve replacement era: increasing deaths and minimal change in mortality rate over the past three decades.
abstract: BACKGROUND
  Valvular heart disease (VHD) is an increasingly common problem in clinical practice. With the development of new but expensive therapeutic options, health care systems require timely epidemiological information on VHD. We sought to determine the mortality burden of VHD and how it has changed over time.
  
  
  METHODS
  Population level data from the United States (US) from 1979 to 2009 were used to examine trends in VHD mortality rates over time. Our outcome measure was death, where the primary cause of death was valvular heart disease.
  
  
  RESULTS
  The annual number of VHD deaths increased from 15,054 in 1979 to 26,663 in 2009, an increase of on average 2.8% in the US each year (R(2) = 0.97, P < .001). The total VHD mortality rate increased with older age and male sex. There was little overall change in age- and sex-adjusted total VHD mortality rate over time (mortality rate ratio per year 0.999, 95% confidence interval 0.999 to 0.999, P < .001). Non-rheumatic aortic valve disease accounted for 45.2% of all VHD deaths. Adjusted mortality rates for aortic valve disease, mitral valve disease and endocarditis increased (P < .001), while that for rheumatic heart disease decreased (P < .001). If VHD mortality rates remain stable, deaths due to VHD are projected to double over the next 25 years.
  
  
  CONCLUSIONS
  Despite improvements in mortality rates for other major conditions and in surgical outcomes for VHD, adjusted VHD mortality rates showed minimal change over the 31 years examined. The ageing population is driving a marked increase in the number of deaths due to VHD.
authors.affiliation: Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; OxVALVE Study, Oxford University Hospitals, Oxford, United Kingdom. Electronic address: sean.coffey@ouh.nhs.uk.
authors.forename: Sean
authors.initials: S
authors.lastname: Coffey
authors.affiliation: Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Brian
authors.initials: B
authors.lastname: Cox
authors.affiliation: Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Michael J A
authors.initials: MJ
authors.lastname: Williams
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology