Large-scale community echocardiographic screening reveals a major burden of undiagnosed valvular heart disease in older people: the OxVALVE Population Cohort Study

Abstract

Background: Valvular heart disease (VHD) is expected to become more common as the population ages. However, current estimates of its natural history and prevalence are based on historical studies with potential sources of bias. We conducted a cross-sectional analysis of the clinical and epidemiological characteristics of VHD identified at recruitment of a large cohort of older people.

Methods and results: We enrolled 2500 individuals aged ≥65 years from a primary care population and screened for undiagnosed VHD using transthoracic echocardiography. Newly identified (predominantly mild) VHD was detected in 51% of participants. The most common abnormalities were aortic sclerosis (34%), mitral regurgitation (22%), and aortic regurgitation (15%). Aortic stenosis was present in 1.3%. The likelihood of undiagnosed VHD was two-fold higher in the two most deprived socioeconomic quintiles than in the most affluent quintile, and three-fold higher in individuals with atrial fibrillation. Clinically significant (moderate or severe) undiagnosed VHD was identified in 6.4%. In addition, 4.9% of the cohort had pre-existing VHD (a total prevalence of 11.3%). Projecting these findings using population data, we estimate that the prevalence of clinically significant VHD will double before 2050.

Conclusions: Previously undetected VHD affects 1 in 2 of the elderly population and is more common in lower socioeconomic classes. These unique data demonstrate the contemporary clinical and epidemiological characteristics of VHD in a large population-based cohort of older people and confirm the scale of the emerging epidemic of VHD, with widespread implications for clinicians and healthcare resources.

Keywords: Echocardiography; Epidemiology; Health policy and outcome research; Valvular heart disease.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Figures

Figure 1

Population prevalence of valvular heart disease according to age.

Figure 2

Venn diagram demonstrating the distribution of single and multiple left-sided valve abnormalities in OxVALVE participants with newly diagnosed valvular heart disease. The outer rectangle represents the full cohort (n = 2500) and the area of each circle is proportionate to the number of participants with different manifestations of left-sided valvular heart disease. Numbers denote the number of participants in each group.

Figure 3

Clinical variables associated with a new diagnosis of valvular heart disease. Forest plot of odds ratios from multiple regression analysis of clinical associations with (A) any valvular heart disease, and (B) significant (moderate/severe) valvular heart disease. Only statistically significant variables are shown. Dots represent the odds ratio and whiskers represent the 95% confidence interval. CI, confidence interval; OR, odds ratio; SEC, socioeconomic class, according to national quintile.

Figure 4

UK population projections of diagnosed and undiagnosed significant valvular heart disease. Diagnosed estimates are based on the number excluded from participation in the present study due to a prior diagnosis of valvular heart disease. Undiagnosed estimates are based on the number with newly diagnosed significant valvular heart disease in OxVALVE-PCS.