Profiles of hospitalized patients with valvular heart disease: Experience of a tertiary center

Abstract

Introduction: Valvular heart disease (VHD) is increasing worldwide, mostly because of aging. Percutaneous valve intervention is the preferred therapeutic option in high-risk patients. Objective: To characterize the profiles of patients with VHD admitted to the cardiology ward at a tertiary referral center. Methods: On the basis of ICD-9 codes for VHD, the discharge notes of 287 patients hospitalized over a 22-month period were reviewed and analyzed. One hundred characteristics were considered. Results: Median age was 74 (23-93) years, and 145 (51%) were male. The admissions were elective (for valve intervention) in 36%. Heart failure (HF) was the reason for urgent admissions in 29.3%. Multiple comorbidities were observed in 53% of patients. Etiology of VHD was degenerative in 68%, functional in 15.3% and rheumatic (predominantly in women and younger patients) in 8.7%. Aortic valve disease was present in 63% (aortic stenosis in 56%), and was associated with HF (p=0.004), atrial fibrillation (AF) (p=0.01), and left ventricular (LV) dilatation (p=0.003) or hypertrophy (p<0.001). Mitral valve disease (51%), mostly mitral regurgitation (degenerative or functional), predominated in women, and was associated with HF, AF, LV dilatation (p<0.001) and reduced LV ejection fraction (p=0.003). Significant tricuspid regurgitation (34.8%) associated with the presence of previously implanted cardiac devices (p<0.001). Valve intervention (mostly transcatheter aortic valve implantation) was performed in 41% of patients. Mean length of hospital stay was 12±14.3 days and overall in-hospital mortality was 9.8%. Conclusions: Nowadays, the profiles of hospitalized patients with VHD are dominated by the elderly, with degenerative disease and multiple comorbidities, presenting with HF, AF and LV remodeling, who frequently undergo valve intervention, usually via a percutaneous approach. Mortality remains significant in this high-risk population. Resumo: Introdução: A doença cardíaca valvular (DCV) é problema crescente, relacionando-se com o envelhecimento populacional. A intervenção valvular por via percutânea é opção preferencial em alguns contextos, inclusive em doentes de elevado risco. Objetivo: Caracterização do perfil dominante do doente com DCV admitido em enfermaria de cardiologia (centro terciário de referência). Métodos: Revisão de processos clínicos de 287 doentes (códigos ICD-9 para DCV) internados num período de 22 meses. Foram consideradas para análise 100 características. Resultados: Idade - 74 (23-93) anos; 145 (51%) homens. Admissões eletivas (intervenção valvular): 36%. Insuficiência cardíaca (IC): causa de admissão urgente em 29,3%. Comorbilidades múltiplas: 53% dos doentes. Etiologias: degenerativa (68%); funcional (15,3%); reumática (8,7%) – predominantemente em mulheres e em doentes mais jovens. Doença valvular aórtica - 63% (estenose em 56%), associou-se à presença de IC (p = 0,004), fibrilhação auricular (FA)- p = 0,014 – e hipertrofia (p < 0,001) ou dilatação ventricular esquerda (VE) – p = 0,003. Doença valvular mitral (51%) - predominantemente regurgitação - degenerativa ou funcional, mais frequente em mulheres; associou-se à presença de IC, FA, dilatação VE – p < 0,001 - e fração de ejeção VE diminuída (p = 0,003). Insuficiência tricúspide (34,8%), associou-se à presença de eletrocatéteres previamente implantados (p < 0,001). Intervenções valvulares: 41% dos doentes, predominantemente TAVI. Duração de internamento: 12 ± 14,3 dias; mortalidade global intra-hospitalar: 9,8%. Conclusões: O perfil atual do doente hospitalizado com DCV é dominado pelo idoso com doença degenerativa e múltiplas comorbidades, apresentando remodelagem VE, IC e FA, e sendo frequentemente submetido a intervenção valvular (predominantemente por via percutânea). A mortalidade é significativa nessa população de risco elevado. Keywords: Valvular heart disease, Epidemiology, Hospitalization, Aortic stenosis, Mitral regurgitation, Palavras-chave: Doença valvular cardíaca, Epidemiologia, Hospitalização, Estenose aórtica, Regurgitação mitral