Population Prevalence of Valvular Heart Disease in the United States: The PREVUE-VALVE Study.

Abstract

Valvular heart disease (VHD) is associated with substantial morbidity, mortality, and health care costs, yet its contemporary prevalence among older adults in the United States is unknown. We performed a decentralized study of older adults (PREVUE-VALVE) to determine the population prevalence of VHD among older Americans. Individuals 65-85 years old who previously filled a prescription at CVS or Walgreens pharmacies were randomly selected; contacted via e-mail, direct mail, or text messaging; and invited to participate. Enrolled participants completed study procedures in their homes, including a comprehensive transthoracic echocardiogram. The primary endpoint was the prevalence of moderate or greater (≥ moderate) VHD, weighted to reflect the U.S. The co-primary endpoint was the prevalence of clinically significant VHD, which also included mild-to-moderate regurgitant disease. The study sample (n = 3,000) was representative of older Americans (median age 71 years, 57.1% female, 14.6% non-Hispanic Black, 9.4% Hispanic). The weighted prevalence of ≥ moderate VHD was 8.2% (95% CI: 7.0%-9.5%), which increased to 18.4% (95% CI: 16.7%-20.2%) for clinically significant VHD. Tricuspid regurgitation was the most common lesion, followed by aortic stenosis, mitral regurgitation, aortic regurgitation, and mitral stenosis. Older age, but not sex, was associated with greater prevalence. In age- and sex-adjusted analyses, non-Hispanic Black individuals had a lower prevalence of any VHD compared with non-Hispanic White individuals (adjusted RR: 0.91; 95% CI: 0.83-0.99), driven predominantly by lower rates of aortic stenosis and regurgitation. There were no significant adjusted differences in VHD prevalence between Hispanic and non-Hispanic individuals. Extrapolation of these data to the U.S. population indicates that at least 4.7 million 65-85-year-olds currently have ≥ moderate VHD, and 10.6 million currently have clinically significant VHD-values that are projected to increase to 6.5 and 14.7 million, respectively, by 2060. In this national in-home echocardiography study, VHD was common among older adults, with important age-related and valve-specific patterns. PREVUE-VALVE establishes the feasibility of large-scale decentralized cardiovascular imaging studies and provides a contemporary foundation for clinical and policy planning related to the burden of VHD. (Age- and Sex-Specific Prevalence of Acquired Valvular Heart Disease (PREVUE-VALVE; NCT05357404).