title: The clinical impact of valvular heart disease in a population-based cohort of subjects aged 80 and older.
abstract: BACKGROUND
  In our ageing society, valvular heart diseases (VHD) have become an increasing public health problem. However, the lack of studies describing the impact of these diseases on the outcome of very old subjects makes it difficult to appreciate their real clinical burden.
  
  
  METHODS
  Prospective, observational, population-based cohort study in Belgium. Five hundred fifty six subjects aged 80 years and older were followed up for 5.1 ± 0.25 years for mortality and 3.0 ± 0.25 years for hospitalization. Echocardiograms were performed at baseline. The Cumulative Illness Rating Scale (CIRS) was calculated for each subject.
  
  
  RESULTS
  The prevalence of moderate-to-severe VHD was 17% (n = 97). Mitral stenosis was more prevalent in women and an age-dependent increase of the prevalence of severe aortic stenosis was seen. The overall disease burden was higher in participants with VHD (median CIRS 3 [IQR 3-5] vs 4 [IQR 3-6] (P = 0.008)). Moderate-to-severe VHD, and more specifically mitral stenosis and aortic stenosis, was found to be an independent predictor of both all-cause (HR 1.42 (95% CI 1.04-1.95)) and cardiovascular mortality (HR 2.13 (95% CI 1.38-3.29)). Moderate-to-severe VHD was also found to be an independent predictor of the need for a first unplanned hospitalization (HR 1.43 (95% CI 1.06-1.94)).
  
  
  CONCLUSIONS
  A high prevalence of moderate-to-severe VHD was found in the very old. Moderate-to-severe VHD was identified as an independent risk factor for all-cause and cardiovascular mortality and as well for unplanned hospitalizations, independent of other structural cardiac abnormalities, ventricular function and major co-morbidities.
authors.affiliation: Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium. reznawel@yahoo.fr.|Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium. reznawel@yahoo.fr.
authors.forename: Nawel
authors.initials: N
authors.lastname: Rezzoug
authors.affiliation: Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium. bert.vaes@med.kuleuven.be.|Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium. bert.vaes@med.kuleuven.be.
authors.forename: Bert
authors.initials: B
authors.lastname: Vaes
authors.affiliation: Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium. christophe.demeester@uclouvain.be.|Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium. christophe.demeester@uclouvain.be.
authors.forename: Christophe
authors.initials: C
authors.lastname: de Meester
authors.affiliation: Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium. Jan.Degryse@med.kuleuven.be.|Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium. Jan.Degryse@med.kuleuven.be.
authors.forename: Jan
authors.initials: J
authors.lastname: Degryse
authors.affiliation: Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium. Gijs.VanPottelbergh@med.kuleuven.be.|Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium. Gijs.VanPottelbergh@med.kuleuven.be.
authors.forename: Gijs
authors.initials: G
authors.lastname: Van Pottelbergh
authors.affiliation: Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium. Catharina.Mathei@med.kuleuven.be.|Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium. Catharina.Mathei@med.kuleuven.be.
authors.forename: Catharina
authors.initials: C
authors.lastname: Mathei
authors.affiliation: Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium. Wim.Adriaensen@med.kuleuven.be.|Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium. Wim.Adriaensen@med.kuleuven.be.
authors.forename: Wim
authors.initials: W
authors.lastname: Adriaensen
authors.affiliation: Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium. Agnes.Pasquet@uclouvain.be.|Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium. Agnes.Pasquet@uclouvain.be.
authors.forename: Agnes
authors.initials: A
authors.lastname: Pasquet
authors.affiliation: Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium. Jean-Louis.Vanoverschelde@uclouvain.be.|Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium. Jean-Louis.Vanoverschelde@uclouvain.be.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vanoverschelde
mesh_terms: D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality; D001530:Belgium / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000401:mortality; D015331:Cohort Studies; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D004452:Echocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality; D009026:Mortality; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology