Cumulative burden of clinically significant aortic stenosis in community-dwelling older adults.
Cumulative burden of clinically significant aortic stenosis in community-dwelling older adults.
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社区居住老年人临床显著主动脉瓣狭窄的累积负担
DOI：
10.1136/heartjnl-2021-319025
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发表时间：
2021-09
期刊：
影响因子：
5.7
通讯作者：
Kizer, Jorge R.
中科院分区：
文献类型：
--
作者：
Owens, David S.;Bartz, Traci M.;Buzkova, Petra;Massera, Daniele;Biggs, Mary L.;Carlson, Selma D.;Psaty, Bruce M.;Sotoodehnia, Nona;Gottdiener, John S.;Kizer, Jorge R.
目前对主动脉瓣狭窄（AS）频率的估计主要依赖于横断面超声心动图或纵向管理数据，使得对AS负担的理解不完整。我们进行了病例判定，以评估AS的频率，并评估年龄，性别和种族在长期随访的老年队列中的差异。我们开发了病例捕获方法，使用研究超声心动图、手术和诊断代码、心力衰竭事件和死亡，对心血管健康研究中的医疗记录进行有针对性的审查，以确定中度或重度AS和相关手术或住院治疗。主要结局为临床显著性AS（重度AS或手术）。事件AS负担的评估是基于亚分布生存方法，而与年龄，性别和种族的关联依赖于原因特异性生存方法。该队列包括5，795名参与者（年龄73±6岁，42.2%男性，14.3%黑人）。在最长25年随访时，具有临床意义的AS的累积频率为3.69%（很可能/明确）至4.67%（可能/很可能/明确），而相应的20年累积发生率为2.88%至3.71%。在事件病例中，约85%因严重AS住院，但约一半未接受瓣膜介入治疗。具有临床意义的AS的校正发生率在男性中较高（HR=1.62 [95% CI=1.21-2.17]），并随年龄增加而增加（HR=1.08 [95% CI=1.04-1.11]），但在黑人中较低（HR=0.43 [95% CI=0.23-0.81]）。在这项以社区为基础的研究中，我们发现了比以前报道的更高的临床显著性AS负担，年龄，性别和种族存在差异。这些发现对公共卫生资源规划具有重要意义，尽管黑人负担较低值得进一步研究。
Current estimates of aortic stenosis (AS) frequency have mostly relied on cross-sectional echocardiographic or longitudinal administrative data, making understanding of AS burden incomplete. We performed case adjudications to evaluate the frequency of AS and assess differences by age, sex and race in an older cohort with long-term follow-up. We developed case-capture methods using study echocardiograms, procedure and diagnosis codes, heart failure events and deaths for targeted review of medical records in the Cardiovascular Health Study to identify moderate or severe AS and related procedures or hospitalizations. The primary outcome was clinically significant AS (severe AS or procedure). Assessment of incident AS burden was based on subdistribution survival methods, while associations with age, sex and race relied on cause-specific survival methods. The cohort comprised 5,795 participants (age 73±6, 42.2% male,14.3% Black). Cumulative frequency of clinically significant AS at maximal 25-year follow-up was 3.69% (probable/definite) to 4.67% (possible/probable/definite), while the corresponding 20-year cumulative incidence was 2.88 to 3.71%. Of incident cases, about 85% had a hospitalization for severe AS, but roughly half did not undergo valve intervention. The adjusted incidence of clinically significant AS was higher in men (HR=1.62 [95% CI=1.21-2.17]) and increased with age (HR=1.08 [95% CI=1.04-1.11]), but was lower in Blacks (HR=0.43 [95% CI=0.23-0.81]). In this community-based study, we identified a higher burden of clinically significant AS than reported previously, with differences by age, sex, and race. These findings have important implications for public health resource planning, although the lower burden in Blacks merits further study.
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DOI：
10.1016/s0735-1097(96)00563-3
发表时间：
1997-03-01
影响因子：
24
作者：
Stewart, BF;Siscovick, D;Otto, CM
通讯作者：
Otto, CM
DOI：
10.1016/0735-1097(93)90249-z
发表时间：
1993-04-01
影响因子：
24
作者：
LINDROOS, M;KUPARI, M;TILVIS, R
通讯作者：
TILVIS, R
影响因子：
5.7
作者：
Eveborn, Gry Wisthus;Schirmer, Henrik;Rasmussen, Knut
通讯作者：
Rasmussen, Knut
影响因子：
37.8
作者：
Psaty BM;Delaney JA;Arnold AM;Curtis LH;Fitzpatrick AL;Heckbert SR;McKnight B;Ives D;Gottdiener JS;Kuller LH;Longstreth WT Jr
通讯作者：
Longstreth WT Jr
影响因子：
24
作者：
Novaro, Gian M.;Katz, Ronit;Griffin, Brian P.
通讯作者：
Griffin, Brian P.