Prospective cohort study of characteristics and sex differences in elderly patients with degenerative valvular disease

OBJECTIVES: We aimed to describe the characteristics and to compare the sex differences in the clinical features and prognosis of Chinese elderly patients with senile degenerative valvular heart disease (VHD). DESIGN: This study was a nationwide, multicentre, prospective cohort study. SETTING: Participants were enrolled consecutively from 69 hospitals nationwide in China from September to December 2016. PARTICIPANTS: A total of 2728 patients aged ≥60 years old with an aetiological diagnosis of moderate to severe degenerative VHD as defined by echocardiography were recruited. MAIN OUTCOME MEASURES: The baseline data and 1-year follow-up data were collected, and disease distribution, clinical features, treatment and prognosis were compared between different sex groups. RESULTS: Aortic disease was more common in men, and mitral disease was more common in women. Male patients were more likely to have smoking, coronary heart disease, cardiomyopathy, chronic obstructive pulmonary disease and coronary artery bypass grafting histories, while female patients had more hypertension and atrial fibrillation. The average age and left ventricular ejection fraction were significantly lower in men than in women (p<0.001), while the intervention rate (p=0.026) and total hospitalisation cost (p=0.016) of male patients were higher than those of female patients. There were no significant differences in perioperative complications, in-hospital outcomes or short and intermediate prognoses between the two groups. CONCLUSIONS: Currently, the intervention rate of elderly patients with VHD is still not ideal, with dominant factor—patient rejection. Heart failure was the critical reason for rehospitalisation. There were some differences between men and women in the distribution, severity, clinical characteristics and interventions in senile degenerative valvular disease.