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Surgery for valvular heart disease: a population-based study in a Brazilian urban center
Guilherme S Ribeiro1, Sara Y Tartof, Dalton W S Oliveira
1Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil. gsribeiro@ufba.br
Insights
Rheumatic heart disease (RHD) is the leading cause of heart valve surgery in Salvador, Brazil, predominantly affecting young adults. Degenerative valve disease impacts the elderly, highlighting different public health needs.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Rheumatic heart disease (RHD) poses a significant burden in middle-income countries.
- Increasing life expectancy may lead to a rise in other heart valve diseases.
Purpose of the Study:
- To compare population-based data on surgical procedures for heart valve disease in Salvador, Brazil.
- To assess the relative importance of different etiologies of heart valve disease.
Main Methods:
- Review of medical charts for 491 patients undergoing valvular heart surgery (2002-2005).
- Calculation of incidence rates for valvular heart disease surgeries.
- Logistic regression analysis to identify factors associated with in-hospital mortality.
Main Results:
- Rheumatic heart disease (RHD) was the most common cause (60.3%) of valvular heart surgery, primarily in young adults and publicly funded.
- Degenerative valve disease accounted for 15.3% of surgeries, predominantly in those over 60 and privately funded.
- In-hospital mortality was 11.9%, with increased age, endocarditis, multiple procedures, and prior surgery being significant risk factors.
Conclusions:
- RHD remains the primary indication for heart valve surgery in Salvador, affecting younger, uninsured populations.
- Degenerative valve disease is more prevalent in older, privately insured individuals.
- Targeted strategies are needed to address the distinct causes and patient demographics of RHD and degenerative valve disease.
Background:
In middle income countries, the burden of rheumatic heart disease (RHD) remains high, but the prevalence of other heart valve diseases may rise as the population life expectancy increases. Here, we compared population-based data on surgical procedures to assess the relative importance of causes of heart valve disease in Salvador, Brazil.
Methodology/Principal Findings:
Medical charts of patients who underwent surgery for valvular heart disease from January 2002-December 2005 were reviewed. Incidence of surgery for valvular heart disease was calculated. Logistic regression was used to identify factors associated with in-hospital death following surgery. The most common etiologies for valvular dysfunction in 491 valvular heart surgery patients were RHD (60.3%), degenerative valve disease (15.3%), and endocarditis (4.5%). Mean annual incidence for surgeries due to any valvular heart diseases, RHD, and degenerative valvular disease were 5.02, 3.03, and 0.77 per 100,000 population, respectively. Incidence of surgery due to RHD was highest in young adults; procedures were predominantly paid by the public health sector. In contrast, the incidence of surgery due to degenerative valvular disease was highest among those older than 60 years of age; procedures were mostly paid by the private sector. The overall in-hospital case-fatality ratio was 11.9%. Independent factors associated with death included increase in age (odds ratio: 1.04 per year of age; 95% confidence interval: 1.02-1.06), endocarditis (6.35; 1.92-21.04), multiple valve operative procedures (4.35; 2.12-8.95), and prior heart valve surgery (2.49; 1.05-5.87).
Conclusions/Significance:
RHD remains the main cause for valvular heart surgery in Salvador, which primarily affects young adults without private health insurance. In contrast, surgery due to degenerative valvular disease primarily impacts the elderly with private health insurance. Strategies to reduce the burden of valvular heart disease will need to address the disparate factors that contribute to RHD as well as degenerative valve disease.
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