| Objectives:The purpose of this study was to describe the demographic characteristics,hospitalization reasons,clinical features,disease stage of valvular heart disease,diagnostic procedures and treatment status of elderly hospitalized patients with senile degenerated heart valvular disease,to analyze the application of auxiliary examinations and treatment strategies under the latest guidelines for valvular heart disease,and to indentify factors about treatment decisions.Through one-year follow-up,the differences in the one-year survival rate of patients with different stages,different age groups or different treatment methods were further analyzed,and the predictors affecting the long-term prognosis were explored.This study aimed to fill the blank in the clinical research field of senile degenerative heart valve disease in China,and provide data support for clinical reach and treatment management strategies for SDHVD patients in China.Methods:The source of data in this study was from China elDerly Valve Disease Cohort Study(China-DVD)database.China-DVD was a large-scale multicenter,observational,and prospective clinical study.Hospitalized patients aging over 60 with a diagnosis of degenerative heart valve disease were enrolled consecutively as main subjects(N=2728).Collect baseline data for all selected cases,including demographic characteristics,clinical features,combined disease,treatment,and in-hospital outcomes,and follow-up visits by telephone or outpatient interviews to collect long-term follow-up data,including death and rehospitalization.According to different gender,age,disease stage and treatment method,2728 subjects were divided into several subgroups in order to make further research and statistical analysis.We use a multivariable logistic model and a multivariable Cox proportional-hazards model respectively to analyze the factors related to treatment decisions and the factors related to long-term survival.Survival curves were estimated and plotted using the Kaplan-Meier method,and comparisons between groups were performed using the Log-rank test.The difference was statistically significant at P<0.05.Results:1.Atotal number of 2728 elderly hospitalized patients with degenerative heart valve disease were enrolled in this study,with an average age of(72.19±7.75)years old.The most common of these was mitral regurgitation(49.81%),followed by tricuspid regurgitation(36.25%)and aortic regurgitation(34.24%).Hypertension was the most common comorbidity(57.95%)in all enrolled patients.The main clinical symptoms were cardiac insufficiency(76.87%),and the most patients were in stage D(46.35%).Only 17.84%of patients had known the valvular heart disease before hospitalization.Furthermore,more than half of patients(53.16%)admitted to hospital for the treatment of cardiovascular diseases other than valvular disease.The proportions of coronary angiography,transesophageal ultrasound,aortic computed tomography,cardiac magnetic resonance,exercise test,and dobutamine stress test were 40.87%,7.88%,7.29%,0.66%,0.51%,and 0.40%,respectively.A total of 762 patients(32.46%)underwent invasive intervention,of which surgical valve replacement was the main(73.36%).64 patients(8.90%)had complications during the perioperative period,with the highest incidence of major bleeding(20.45%).Among the patients undergoing prosthetic valve replacement surgery,364(64.88%)cases were selected for bioprosthesis and 197(35.12%)cases were selected for mechanical valve.56.60%of the patients with conservative drug therapy assessed that there was no need for surgery at present.While among the patients with surgical indications,high-risk patients accounted for 27.01%.The main reason for choosing conservative drug therapy was that the patients rejection(34.09%).The all-cause mortality rate in the hospital was 1.1%.The one-year follow-up rate was 75.62%,and the median follow-up time was 373 days.The rate of re-admission was 17.21%a year,mainly due to aggravated heart failure.One-year all-cause mortality was 10.04%.Univariate analysis showed that patients in the death group were older,lower BMI,more with diabetes,aortic disease,renal insufficiency,chronic obstructive pulmonary disease,more in NYHA cardiac functiongrade Ⅳ and phase D,more with conservative treatment.2.Among all enrolled patients,1520 were male(55.72%).Aortic valve disease was more common in male patients and mitral valve disease was more common in female patients.The mean age and mean LVEF of male patients were lower than those of females(P<0.001).The rate of repeated hospitalization for valvular disease(P=0.027),invasive intervention(P=0.026),and total hospitalization(P=0.016)was higher in male patients than in female patients.3.Among patients of different age groups,1150(42.16%)were 60-69 years old,and 1033(37.86%)were 70-79 years old,with the most common mitral regurgitation,545(19.98%)patients were over 80 years old,with the most common tricuspid regurgitation.Among the three groups of patients,the proportion of male patients gradually decreased(P=0.003).The number of invasive interventions in the three groups was 485(42.17%),205(19.85%),and 29(5.32%),respectively(P<0.001).Patients in 60-69 age and 70-79 age group were mainly treated with surgical valve surgery,while those over 80 years old were mainly treated with TAVR(13 cases,44.83%).The incidence of postoperative complications in the three groups was 49(10.10%),33(16.10%),and 6(20.69%),respectively(P=0.033).4.According to the stage of disease,the proportion of patients with invasive intervention in different stages was 135(12.37%)in stage B,47(14.78%)in stage C1,5(31.25%)in stage C2,and 528(42.48%)in stage D.In patients with severe SDHVD(stage C+D),age and LVEF were the main factors influencing the choice of treatment options according to multivariate Logistic regression analysis.5.Among the patients with stage B and C who completed the 1-year follow-up,the rate of rehospitalization in the drug-treated group was higher than that in the invasive intervention group,but there was no significant difference in all-cause mortality.Among the patients in stage D,all-cause mortality and the rate of rehospitalization in the drug-treated group was higher than that of the invasive intervention group.According to the Kaplan-Meier survival curve and Log-rank test results,the all-cause mortality rate was statistically different among patients of different age groups.The mortality rate of patients over 70 years old was higher than that of patients under 70 years old(P=0.043).Among the patients in different stages,the one-year survival rate was different between patients with stage B and C1,C2,and D(P<0.001),and between patients with C1,C2,and D(P<0.001).Among the patients with different LVEF stratification,except LVEF<50%and LVEF<40%,LVEF<30%,as well as LVEF<40%and LVEF<30%,the one-year survival rate were different among other groups.Multivariate Cox risk regression analysis showed:chronic obstructive pulmonary disease(P=0.003;HR=2.697;95%Cl,1.407-5.167),systolic blood pressure(P=0.011;HR=0.985;95%Cl,0.973-0.996)NT-pro BNP(P=0.002;HR=1.046;95%Cl,1.017-1.076)was a predictor of all-cause mortality in SDHVD hospitalized patients.Conclusions:This study provides an epidemiological survey of tcurrent status and prognosis of large-scale elderly patients with degenerative valvular heart disease in China.1.The most common SDHVD in China is mitral regurgitation.Most patients have unknown valvular heart disease before hospitalized.2.A large number of hospitalized patients with SDHVD have multiple systemic comorbities,an impaired LVEF.More than half of the patients are admitted to hospital for other cardiovascular diseases other than valvular disease.3.Aortic valve lesions are dominant in male patients,and mitral valve lesions are dominant in female patients.The proportion of male patients decreased gradually with the increase of age.4.The invasive intervention rate of this study is 32.46%,which in male patients were higher than female patients,and the later the disease stage,the higher the proportion of invasive intervention treatment.Age,LVEF value are the factors that affect the choice of treatment options for patients with severe SDHVD.5.For patients of different age groups,the proportion of invasive interventions gradually decreased,and patients with over 70 years of age have a one-year all-cause mortality rate higher than those under 70 years of age.6.For patients with stage D,all-cause mortality and rehospitalization rates are higher in the drug-treated group than in the invasive intervention group.7.The one-year all-cause mortality of hospitalized patients with SDHVD is associated with chronic obstructive pulmonary disease,systolic blood pressure,and NT-pro BNP. |
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