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Circulation
February 23, 2010
Isolated mitral stenosis is more common in women and occurs in 40% of all patients presenting with rheumatic heart disease.17 The NHLBI-sponsored FHS reports that among people 26 to 84 years of age, prevalence of mitral valve disorders is ⬇1% to 2% and equal between women and men.18 The prevalence of mitral valve prolapse in the general population was evaluated with the use of echocardiograms of 1845 women and 1646 men who participated in the fifth examination of the Offspring Cohort of the FHS. The prevalence of mitral valve prolapse was 2.4%. The frequencies of chest pain, dyspnea, and ECG abnormalities were similar among subjects with prolapse and those without prolapse.18
Pulmonary Valve Disorders ICD-9 424.3; ICD-10 I37. Mortality—12. Any-mention mortality—28. Tricuspid Valve Disorders ICD-9 424.2; ICD-10 I36. Mortality—12 Any-mention mortality—93. Endocarditis, Valve Unspecified ICD-9 424.9; ICD-10 I38. Mortality—5029 Any-mention mortality—10 186.
Arrhythmias (Disorders of Heart Rhythm) ICD-9 426, 427; ICD-10 I46-I49. Mortality—36 860. Any-mention mortality— 461 016. Hospital discharges— 835 000. ●
In 2006, $3.1 billion ($7783 per discharge) was paid to Medicare beneficiaries for cardiac dysrhythmias.19
Atrial Fibrillation and Flutter ICD-9 427.3; ICD-10 I48. Mortality—11 438. Any-mention mortality—90 000. Prevalence —⬎2.2 million, projected to 2.66 million in 2010.20,21 Incidence—⬎75 000.21 Hospital discharges— 461 000. ●
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Participants in the NHLBI-sponsored FHS study were followed up from 1968 to 1999. At 40 years of age, remaining lifetime risks for AF were 26.0% for men and 23.0% for women. At 80 years of age, lifetime risks for AF were 22.7% for men and 21.6% for women. In further analysis, counting only those who had development of AF without prior or concurrent HF or MI, lifetime risk for AF was ⬇16%.22 Data from a large community-based population suggest that AF is less prevalent in blacks than in whites, both overall and in the setting of CHF.20,23 Data from the NHDS/NCHS (1996 –2001) on cases that included AF as a primary discharge diagnosis found the following24: — Approximately 44.8% of patients were men. — The mean age for men was 66.8 years, versus 74.6 years for women.
— The racial breakdown for admissions was 71.2% white, 5.6% black, and 2.0% other races (20.8% were not specified). — Black patients were much younger than patients of other races. — The incidence in men ranged from 20.58/100 000 persons per year for patients between 15 and 44 years of age to 1077.39/100 000 persons per year for patients ⱖ85 years of age. In women, the incidence ranged from 6.64/100 000 persons per year for patients between 15 and 44 years of age to 1203.7/100 000 persons per year for those ⱖ85 years of age. — From 1996 to 2001, hospitalizations with AF as the first-listed diagnosis increased 34%. ●
In 1999, the CDC analyzed data from national and state multiple-cause mortality statistics and Medicare hospital claims for persons with AF. The most common disease listed as the primary diagnosis for persons hospitalized with AF was HF (11.8%), followed by AF (10.9%), CHD (9.9%), and stroke (4.9%).25 In Olmsted County, Minnesota, the age-adjusted incidence of clinically recognized AF in a white population increased by 12.6% between 1980 and 2000.26,27 — The incidence of AF was greater in men (incidence ratio for men over women, 1.86) and increased markedly with older age.26 — If incidence estimates are applied to US population projections from the Census Bureau, the projected number of persons with AF may exceed 12 million by 2050.26 — Among Medicare patients ⱖ65 years of age, AF prevalence increased from 3.2% in 1992 to 6.0% in 2002, with higher prevalence in older subsets of the study population. Stroke rates per 1000 patient-years declined from 46.7 in 1992 to 19.5 in 2002 for ischemic stroke but remained fairly steady for hemorrhagic stroke (1.6 to 2.9).28 — AF independently increases the risk of ischemic stroke by 4- to 5-fold.29 — AF is responsible for at least 15% to 20% of all ischemic strokes.21 — Paroxysmal, persistent, and permanent AF all appear to increase the risk of ischemic stroke to a similar degree.30 — AF is also an independent risk factor for ischemic stroke severity and recurrence. In one study, persons who have AF and are not treated with anticoagulants had a 2.1-fold increase in risk for recurrent stroke and a 2.4-fold increase in risk for recurrent severe stroke.31 — Isolated chronic atrial flutter is uncommon but is associated with a high risk of developing AF,32 and data from a sample of 191 patients with chronic atrial flutter revealed a risk of ischemic stroke that was similar to that for AF.33 — A study of ⬎4600 patients diagnosed with first AF showed that risk of death within the first 4 months after the AF diagnosis was high. The most common causes
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