Aortic Stenosis in the Elderly
Open accessAbstract
Objectives The purpose of this study was to evaluate the prevalence of aortic stenosis (AS) in the elderly and to estimate the current and future number of candidates for transcatheter aortic valve replacement (TAVR).Background Severe AS is a major cause of morbidity and mortality in the elderly. A proportion of these patients is at high or prohibitive risk for surgical aortic valve replacement, and is now considered for TAVR.Methods A systematic search was conducted in multiple databases, and prevalence rates of patients (>75 years) were pooled. A model was based on a second systematic literature search of studies on decision making in AS. Monte Carlo simulations were performed to estimate the number of TAVR candidates in 19 European countries and North America.Results Data from 7 studies (n = 9,723 subjects) were used. The pooled prevalence of all AS in the elderly was 12.4% (95% confidence interval [CI]: 6.6% to 18.2%), and the prevalence of severe AS was 3.4% (95% CI: 1.1% to 5.7%). Among elderly patients with severe AS, 75.6% (95% CI: 65.8% to 85.4%) were symptomatic, and 40.5% (95% CI: 35.8% to 45.1%) of these patients were not treated surgically. Of those, 40.3% (95% CI: 33.8% to 46.7%) received TAVR. Of the high-risk patients, 5.2% were TAVR candidates. Projections showed that there are approximately 189,836 (95% CI: 80,281 to 347,372) TAVR candidates in the European countries and 102,558 (95% CI: 43,612 to 187,002) in North America. Annually, there are 17,712 (95% CI: 7,590 to 32,691) new TAVR candidates in the European countries and 9,189 (95% CI: 3,898 to 16,682) in North America.Conclusions With a pooled prevalence of 3.4%, the burden of disease among the elderly due to severe AS is substantial. Under the current indications, approximately 290,000 elderly patients with severe AS are TAVR candidates. Nearly 27,000 patients become eligible for TAVR annually.
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The burden of calcific aortic stenosis is expected to rise over the coming decades because of population aging and the absence of a prevention strategy that reduces disease progression.
“The burden of calcific AS in the community is expected to increase over the next decades owing to population aging and the lack of a prevention strategy aimed at reducing disease progression.”
From Calcific aortic stenosis (2016) · cites this paper as [16]
The introductory passage following Conclusions (pp. 1002–12) expects the public-health impact of aortic stenosis to increase as populations age. The Results also projects more elderly patients with symptomatic severe aortic stenosis in 2025 and 2050. Our copy does not identify the absence of a prevention strategy that slows progression as a reason for that increase. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn developed countries, the number of patients with calcific aortic stenosis older than 70 or 75 years is predicted to increase twofold to threefold over the next 50 years.
“Estimates based on current prevalence rates and demographic forecasts predict that the number of patients with calcific AS >70 or >75 years of age will increase twofold to threefold over the next 50 years in developed countries15;16;19.”
From Calcific aortic stenosis (2016) · cites this paper as [16]
The Results project that symptomatic severe aortic stenosis in people aged 75 or older will rise from 1.0 to 2.1 million in the studied European countries and from 540,000 to 1.4 million in North America by 2050—roughly a twofold to threefold increase. The paper does not give that projection specifically for calcific stenosis, people over 70, or a 50-year period. The indexed Results passage has no page number. (LLM, conf=0.85)
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- Authors
- Osnabrugge, R. L. J., Mylotte, D., Head, S. J., Van Mieghem, N. M., Nkomo, V. T., LeReun, C. M., Bogers, A. J. J. C., Piazza, N., & Kappetein, A. P.
- Affiliations
- Erasmus MC (NL)
- McGill University Health Centre (CA)
- Mayo Clinic (US)
- Corresponding author
- Kappetein, A. Pieter
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-09
- Volume
- 62
- Issue
- 11
- Pages
- 1002-1012
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W1575075233
- Cited by
- 1,378
- References
- 31
- Citations by year
- 2026: 130 · 2025: 157 · 2024: 156 · 2023: 144 · 2022: 127 · 2021: 116 · 2020: 112 · 2019: 98 · 2018: 91 · 2017: 76 · 2016: 84 · 2015: 45 · 2014: 25 · 2013: 10 · 2012: 1
- FWCI
- 37.19
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- ARAN (University of Galway Research Repository) (Ollscoil na Gaillimhe – University of Galway) (acceptedVersion, cc-by-nc-nd)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Arrow@dit (Dublin Institute of Technology) (submittedVersion)
- ARAN (University of Galway Research Repository) (Ollscoil na Gaillimhe – University of Galway) (submittedVersion, cc-by-nc-nd)
- ARAN (University of Galway Research Repository) (Ollscoil na Gaillimhe – University of Galway) (submittedVersion, cc-by-nc)
- Research Repository UCD (University College Dublin) (cc-by-nc)
- Funders
- Medtronic
- Edwards Lifesciences
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Keywords
- aortic stenosis, older adults, prevalence, transcatheter aortic valve implantation, high-risk surgical patients, surgical aortic valve replacement, disease burden, decision-making, Monte Carlo simulation, North America, symptomatic aortic stenosis, cost-effectiveness, quality of life
- MeSH terms
- Aged, Aged, 80 and over, Aortic Valve, Aortic Valve Stenosis, Cross-Sectional Studies, Europe, Female, Humans, Male, North America, Risk Factors, Severity of Illness Index, Prevalence, Heart Valve Prosthesis Implantation
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