Epidemiology Of Valvular Heart Diseases: A 30-Year Retrospective Of Hospitalizations And In-Hospital Mortality In New York State

Background: Valvular heart disease (VHD) is among the most predictable causes of heart failure (HF) and an important cause of sudden death. Temporal trends of clinically significant VHD during the past three decades have not been defined. Methods: To obtain information for our region, we conducted a longitudinal analysis of all inpatient hospital records (79,689,879) obtained from the New York State (NYS) Statewide Planning and Research Cooperative System (SPARCS) database for years 1983 (first year reliable data were consistently available) through 2012 (last year data were complete). VHD cases (2,720,313) were identified from principal or secondary ICD-9 codes for aortic, mitral, tricuspid or pulmonic VHD. Linear regression was used to evaluate trends over time for VHD hospitalizations, valve surgery (VS) and in-hospital deaths. Logistic regression was used to predict mortality risk factors. Results: From 1983-2012, total hospitalizations decreased by ~500,000 cases; simultaneously, VHD hospitalizations increased markedly (34,395 in 1983 to 125,139 in 2012). Rate of increase was linear across all VHD categories = 4,248 new cases (12.4%)/yr, r 2 = 0.99, p<.0001) through 2006 (peak= 132,323 cases), and then flattened through 2012. A parallel trend was found for VS, though no appreciable flattening occurred (2,582 cases in 1983 to 7,787 in 2012, linearized increase rate=207 VS [8.0%]/yr, r 2 =0.97, p<.001). Both numbers of hospitalizations and performance of VS rose with patient age (p<.001). Over the study interval, 123,787 patients with VHD died in the hospital, including 9,272 who died after VS; avg case fatality rates were 4.6% (all VHD) and 6.4% (VS). Deaths were independently associated with advancing age, nonelective admission and presence of associated HF (p<.0001, all). Male gender predicted increased death risk among the general VHD population; female gender predicted death risk among those undergoing VS. Conclusions: The incidence of VHD hospitalization and VS in NYS has risen substantially since the early 1980s and can be expected to rise further as the population ages. Thus, intensive planning is needed to deal with public health implications of these trends as we attempt to meet the growing needs of this patient population.