title: Temporal Trends in Disease Severity and Predicted Surgical Risk at the Time of Referral for Echocardiography in Patients Diagnosed with Aortic Stenosis.
abstract: BACKGROUND
  Calcific aortic stenosis (AS) is the most common underlying pathology in patients undergoing heart valve surgery, with an expected increasing prevalence among the aging population.
  
  
  RESULTS
  We identified the temporal trends in referral patterns, disease severity, and associated surgical risk among patients with AS between January 1, 1995 and December 31, 2012 at the Duke University Hospital. A total of 6103 patients had a finding of mild (n = 3303), moderate (n = 1648), or severe AS (n = 1152) in a native aortic valve. Overall presence of severe AS increased significantly over time (P = 0.009) with the most substantial increase occurring from 2010 and onward. Median age upon referral (P < 0.001) and attendant predicted surgical risk (P < 0.001) increased significantly in the observation period among patients with a finding of severe AS. Among patients with a finding of severe AS, the proportion of patients aged older than 80 years increased to 51.0% in the most recent time period (2010-2012) compared with 32.6% in the preceding time period (P < 0.001 for overall time trend). Similarly, the proportion of patients with a logistic EuroSCORE greater than 20% increased to 21.3% (2010-2012) from 12.1% (pre-2010).
  
  
  CONCLUSIONS
  Among patients referred for echocardiography to a high-volume tertiary hospital center, a significant increase in the prevalence of severe AS was observed over time. This trend occurred in parallel with increasing age and predicted surgical risk at referral. Health-care resource planning should account for an increasing number of patients in need of high-risk aortic valve replacements in the near future.
authors.affiliation: From the *Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC; †Department of Cardiology, The Heart Center, University of Copenhagen Rigshospitalet, Denmark; and ‡The Duke Clinical Research Institute, Duke University, Durham, NC.
authors.forename: Mads
authors.initials: M
authors.lastname: Ersboll
authors.forename: Zainab
authors.initials: Z
authors.lastname: Samad
authors.forename: Fawaz
authors.initials: F
authors.lastname: Al Enezi
authors.forename: Joseph
authors.initials: J
authors.lastname: Kisslo
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Schulte
authors.forename: Linda K
authors.initials: LK
authors.lastname: Shaw
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Harrison
authors.forename: Thomas
authors.initials: T
authors.lastname: Bashore
authors.forename: Matthew
authors.initials: M
authors.lastname: Brennan
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012017:Referral and Consultation; D018570:Risk Assessment; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D013997:Time Factors