Temporal Trends in Incidence and Prognosis of Aortic Stenosis: A Nationwide Study of the Swedish Population
Background—The aging of western populations is expected to result in increasing occurrence of aortic stenosis (AS), but data is limited. Recent studies have reported declining incidence and mortality for other major heart diseases. We aimed to study temporal trends in incidence and prognosis for AS in Sweden.
Methods and Results—Using nationwide registers, all adult patients in the Swedish population with a first diagnosis of AS, heart failure, acute myocardial infarction, and aortic valve replacement (AVR) for AS between 1989-2009 were identified and followed until the end of 2010 for all-cause and cardiovascular related mortality. The age-adjusted incidence of AS in Sweden declined from 15.0 to 11.4 in men and 9.8 to 7.1 in women per 100,000 between 1989-1991 and 2007-2009, and the median age at diagnosis increased by 4 years for both men and women. The age- and sex-adjusted relative risk of 1- and 3-year mortality in 2007-2009 was 0.58 (95% CI=0.53-0.63) and 0.60 (95% CI=0.56-0.65) respectively, compared to 1989-1991. Similar improvements were observed for heart failure and acute myocardial infarction. Findings were broadly consistent across subgroups. Postoperative mortality at 30 days declined, despite increased median age at diagnosis.
Conclusions—Incidence and mortality rates in AS in Sweden declined between 1989-2009 to a similar extent as observed for heart failure and acute myocardial infarction. These findings could suggest that improved risk factor control and cardiovascular therapy combined with increased utilization of AVR in the elderly and reduced perioperative mortality in AVR have translated into favorable effects for AS.
- Received August 22, 2014.
- Revision received December 8, 2014.
- Accepted December 11, 2014.