Grant: Operating Grant

Aortic stenosis is the most common form of valvular heart disease in Canada. It is currently estimated that 5% of people > 75 years old have this condition. The prevalence of aortic stenosis is increasing rapidly because of our aging society. Aortic stenosis is a deadly condition since once symptoms develop, more than 25% of patients die each year. Traditionally, open-heart surgery to replace the heart valve has been the definitive treatment. Recently, a novel minimally-invasive technique has been developed to implant a stent within the diseased valve without the need for open-heart surgery. This new treatment option has brought new hope to many high risk patients with aortic stenosis. However, pilot analyses suggest that only 50% of patients with this condition received valve surgery in Ontario. Furthermore, the one-year death rate for patients who did not receive surgery was dramatically higher at 41% as compared to only 9% for those who received surgery. It is unclear whether these observations reflect appropriate or inappropriate care patterns. However, it is clear that additional research is needed in this area. Our grant aims to improve the quality of care and outcomes of patients with severe aortic stenosis. For this project, we will first evaluate treatment patterns of severe aortic stenosis in contemporary practice and determine the factors which explain these treatment patterns. Second, we will develop a series of risk prediction tools to improve clinical decision making during treatment of severe aortic stenosis. Finally, we will examine the importance of competing risks in severe aortic stenosis treatment by evaluating the association of aortic valve surgery utilization with predicted risks of cardiac and non-cardiac death. We fully expect that results from the grant projects will have a significant impact on the treatment of severe aortic stenosis, not only in Canada but internationally.