Trends of Mortality in Patients with Aortic Stenosis and Heart Failure in United States: A Two Decade Analysis

Abstract

Objective: Aortic stenosis (AS) is a common valvular disorder that often coexists with heart failure (HF), creating a complex clinical syndrome associated with high mortality. This is the first study that examines the trends in mortality among patients with AS and HF in the United States over a two-decade period. Methodology: The data was collected from Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research (CDC WONDER) database to examine the aortic stenosis and heart failure related mortality trends in individuals aged 45 years and older, stratified by demographic, geographic, and urbanization factors, from 1999 - 2020. Crude and age‐adjusted mortality rates (AAMRs) per 100 000 people and annual percentage change (APC) with 95% CIs were calculated. Results: The overall AAMR was 9.21 per 100,000 from 1999 – 2020 with an incline from 8.73 in 1999 to 9.08 in 2020. An increase in mortality was observed from 1990 – 2013 with an APC of 0.76 with a steady state decline from 2013 onwards with an APC of -0.55. The mortality was consistently higher in males as compared to females and the gender gap widened overtime. Mortality in females declined from 2015 onwards with an APC of -1.54. Mortality in males inclined from 2002 to 2013 with an APC of 1.47, thereafter showing a steady decline from 2013 onwards with an APC of -0.37. Higher AAMRs were observed in non – metropolitan areas as compared to metropolitan areas. Non-Hispanic (NH) Whites had the highest AAMR while NH Asian or Pacific Islander had the lowest. Across regions, the highest AAMR was observed in western region followed by Northeast with Oregon State showing the highest AAMR followed by Vermont. Conclusion: Mortality in AS and HF patients remains high despite treatment advances. Gender, racial, and regional disparities need addressing to improve patient outcomes.