Comparison of incidence, prevalence and death of aortic stenosis and aortic insufficiency in a nationwide Korean study

Aims: Few studies have examined the incidence, prevalence, survival rate and death risk for non-rheumatic and rheumatic aortic stenosis (AS; RAS), aortic insufficiency (AR; RAR) and aortic stenosis with insufficiency (ASAR; RASAR). This study aims to identify the epidemiology of AS, AR, ASAR, RAS, RAR and RASAR. Methods and results: Data were collected from newly diagnosed non-rheumatic and rheumatic aortic valve disorders (AVD, ICD-10: I35 and I06, n = 101 895, female: male = 6:4) including AS, AR, ASAR, RAS, RAR and RASAR, excluding congenital heart disease. The data were sourced from the National Health Insurance Service in Korea from 2006 through 2017. Among all AVD, AR had the highest distribution. More than 70% of AVD patients were age ≥ 60 years. The age-standardized incidence of non-rheumatic AVD remained stable over the decade while the age-standardized prevalence increased. Conversely, both the incidence and prevalence of rheumatic AVD decreased. The 10 year survival rates (SR) of AS (49.2%), ASAR (50.2%) and RAS (51.4%) were lower than those for AR (64.5%) and RAR (69.2%). The adjusted hazard ratio for AVD was higher in individuals who were older, male, had a lower income level, diabetes mellitus, myocardial infarction, heart failure, atrial fibrillation, stroke, chronic kidney disease or malignant neoplasms. Conclusions: Over 70% of AVD patients were age ≥ 60 years. The 10 year SR of AS, ASAR and RAS exhibited similar patterns, all of which were lower than the SR for other AVD. AVD portends a worse prognosis in older individuals, males, those with lower income levels and those with comorbidities.