UH Team Publishes Important Data on Aortic Stenosis in JAMA

Decrease in mortality in older adults likely reflects the introduction and the advances in TAVR

UH Clinical Update | July 2019

A team from UH Harrington Heart & Vascular Institute recently identified trends in mortality from aortic stenosis in the United States since the introduction of the transcatheter aortic valve replacement (TAVR) procedures, publishing their findings in the prestigious Journal of the American Medical Association (JAMA)¹.

The group analyzed 139,229 death records in the United States between 2008 and 2017 – deaths attributable to aortic stenosis.

“We found that there has been a reduction of mortality due to aortic stenosis since 2013, especially among people ≥80 years,” says Graham Bevan, MD, a resident at University Hospitals and the first author of the study. “This trend was consistent among sexes, but was not observed among people younger than 80 years old, minorities and people living in non-metropolitan areas.”

According to Sadeer Al-Kindi, MD, a physician with UH Harrington Heart & Vascular Institute and the senior author of the study, the decrease in mortality from aortic stenosis in the older population likely reflects the introduction and the advances in TAVR. 

“Since its approval by the U.S. Food and Drug Administration in late 2011, the performance of TAVR procedures has increased significantly in the United States, exceeding the number of surgical aortic valve replacements,” he says. “Because it carries lower risk than surgical valve replacements, transcatheter aortic valve replacement is offered to patients who would have not been offered surgery traditionally, which is likely responsible for the mortality reduction among older patients seen in our analysis.”

“These findings should be inspirational to all who are involved in the care of patients with aortic valve stenosis,” says Richard Josephson, MS, MD, a cardiologist at UH Harrington Heart & Vascular Institute and a co-author of the study. “Individual clinicians typically care for one individual at a time, and often do not see the impact of what they do on a population-wide basis. Those involved in device development and health policy are often forward-looking, and are not certain of the real world impact of their efforts. This analysis clearly shows that the relationship of the deployment of an innovative procedure, one patient at a time, can have a profound and positive impact upon the health of the country.” 

“The data should be interpreted with caution due to the uncertainty about the lack of data on procedures and circumstances of death,” adds David Zidar, MD, PhD, an interventional cardiologist at UH Harrington Heart & Vascular Institute and a co-author of the study. “However, it should be encouraging to patients and the teams of clinicians involved in the care of aortic stenosis.”

¹Mortality Due to Aortic Stenosis in the United States, 2008-2017, JAMA. 2019 Jun 11;321(22):2236-2238. doi: 10.1001/jama.2019.6292.