Advertisement
Mayo Clinic Proceedings Home

Mortality Due to Mitral Regurgitation Among Adults in the United States: 1999-2018

      Abstract

      Objective

      To evaluate the nationwide trends in mortality due to mitral regurgitation (MR) among American adults from 1999 to 2018.

      Patients and Methods

      Trends in mortality due to MR were assessed using retrospective cross-sectional analyses of nationwide mortality data from death certificates of all American residents between January 1, 1999, and December 31, 2018, using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Piecewise linear regression was used to evaluate the trends in the overall population and in subgroups.

      Results

      Among 45,982 deaths due to MR during the study period, higher mortality rates were seen in older White females from the western United States. In 1999, the crude and age-adjusted mortality rates were 27.4 (95% CI, 26.3 to 28.4) and 27.5 (95% CI, 26.4 to 28.5) per 1,000,000 persons, respectively. By 2018, these rates declined to 18.0 (95% CI, 17.3 to 18.7) and 17.7 (95% CI, 17.0 to 18.4) per 1,000,000 persons, respectively (P<.001 for trend for both). Crude mortality rates declined from 1999 to 2012 (annual percentage change [APC], −4.1 (95% CI, −4.6 to −3.6) but then increased after 2012 (APC, 2.6 [95% CI, 0.8 to 4.4; P<.001 for change in trend]). The age-adjusted mortality rates declined from 1999 to 2012 (APC, −3.9 [95% CI, −4.4 to −3.4]) but subsequently increased after 2012 (APC, 1.4 [95% CI, −0.4 to 3.2; P<.001 for change in trend]). The observed decrease was consistent across age, sex, race, geographic region, and urbanization subgroups (P<.05 for all).

      Conclusion

      Mortality due to MR in American adults declined at an annual rate of approximately 4% until 2012 and has since then increased by about 1.5% annually. These mortality trends warrant further investigation.

      Abbreviations and Acronyms:

      AAMR (age-adjusted mortality rate), APC (annual percentage change), CDC (Centers for Disease Control and Prevention), ICD-10 (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision), MR (mitral regurgitation), WONDER (Wide-Ranging Online Data for Epidemiologic Research)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nkomo V.T.
        • Gardin J.M.
        • Skelton T.N.
        • Gottdiener J.S.
        • Scott C.G.
        • Enriquez-Sarano M.
        Burden of valvular heart diseases: a population-based study.
        Lancet. 2006; 368: 1005-1011
        • Benjamin E.J.
        • Muntner P.
        • Alonso A.
        • et al.
        American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2019 update: a report from the American Heart Association [published correction appears in Circulation. 2020;141(2):e33].
        Circulation. 2019; 139: e56-e528
        • Rossi A.
        • Zoppini G.
        • Benfari G.
        • et al.
        Mitral regurgitation and increased risk of all-cause and cardiovascular mortality in patients with type 2 diabetes.
        Am J Med. 2017; 130: 70-76.e1
        • Singh J.P.
        • Evans J.C.
        • Levy D.
        • et al.
        Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study) [published correction appears in Am J Cardiol. 1999;84(9):1143].
        Am J Cardiol. 1999; 83: 897-902
        • Avierinos J.-F.
        • Gersh B.J.
        • Melton III, L.J.
        • et al.
        Natural history of asymptomatic mitral valve prolapse in the community.
        Circulation. 2002; 106: 1355-1361
        • Gammie J.S.
        • Chikwe J.
        • Badhwar V.
        • et al.
        Isolated mitral valve surgery: the Society of Thoracic Surgeons Adult Cardiac Surgery Database analysis.
        Ann Thorac Surg. 2018; 106: 716-727
        • Suri R.M.
        • Vanoverschelde J.-L.
        • Grigioni F.
        • et al.
        Association between early surgical intervention vs watchful waiting and outcomes for mitral regurgitation due to flail mitral valve leaflets.
        JAMA. 2013; 310: 609-616
        • Lazam S.
        • Vanoverschelde J.-L.
        • Tribouilloy C.
        • et al.
        MIDA (Mitral Regurgitation International Database) Investigators. Twenty-year outcome after mitral repair versus replacement for severe degenerative mitral regurgitation: analysis of a large, prospective, multicenter, international registry.
        Circulation. 2017; 135: 410-422
        • El Sabbagh A.
        • Reddy Y.N.V.
        • Nishimura R.A.
        Mitral valve regurgitation in the contemporary era: insights into diagnosis, management, and future directions.
        J Am Coll Cardiol Img. 2018; 11: 628-643
        • Sorajja P.
        • Mack M.
        • Vemulapalli S.
        • et al.
        Initial experience with commercial transcatheter mitral valve repair in the United States.
        J Am Coll Cardiol. 2016; 67: 1129-1140
        • Feldman T.
        • Foster E.
        • Glower D.D.
        • et al.
        EVEREST II Investigators. Percutaneous repair or surgery for mitral regurgitation.
        N Engl J Med. 2011; 364: 1395-1406
        • Stone G.W.
        • Lindenfeld J.
        • Abraham W.T.
        • et al.
        COAPT Investigators. Transcatheter mitral-valve repair in patients with heart failure.
        N Engl J Med. 2018; 379: 2307-2318
        • Obadia J.-F.
        • Messika-Zeitoun D.
        • Leurent G.
        • et al.
        • MITRA-FR Investigators
        Percutaneous repair or medical treatment for secondary mitral regurgitation.
        N Engl J Med. 2018; 379: 2297-2306
        • Arora G.
        • Patel N.
        • Arora P.
        Futile MITRA-FR and a positive COAPT trial: where does the evidence leave the clinicians [letter]?.
        Int J Cardiol Heart Vasc. 2018; 22: 18-19
        • US Food and Drug Administration
        FDA approves new indication for valve repair device to treat certain heart failure patients with mitral regurgitation [press release].
        (Published March 14, 2019. Accessed February 12, 2020)
        • Centers for Disease Control and Prevention
        CDC WONDER: about multiple cause of death 1999-2018.
        http://wonder.cdc.gov/mcd-icd10.html
        Date accessed: June 29, 2020
        • Bevan G.H.
        • Zidar D.A.
        • Josephson R.A.
        • Al-Kindi S.G.
        Mortality due to aortic stenosis in the United States, 2008-2017.
        JAMA. 2019; 321: 2236-2238
        • Tapper E.B.
        • Parikh N.D.
        Mortality due to cirrhosis and liver cancer in the United States, 1999-2016: observational study.
        BMJ. 2018; 362: k2817
        • Shah N.S.
        • Lloyd-Jones D.M.
        • O'Flaherty M.
        • et al.
        Trends in cardiometabolic mortality in the United States, 1999-2017.
        JAMA. 2019; 322: 780-782
        • Sidney S.
        • Go A.S.
        • Jaffe M.G.
        • Solomon M.D.
        • Ambrosy A.P.
        • Rana J.S.
        Association between aging of the US population and heart disease mortality from 2011 to 2017.
        JAMA Cardiol. 2019; 4: 1280-1286
        • National Cancer Institute, Division of Cancer Control and Population Sciences
        Joinpoint regression program, version 4.7.0.0.
        (January 2019)
        https://surveillance.cancer.gov/joinpoint/
        Date accessed: December 2, 2019
        • Kim H.J.
        • Fay M.P.
        • Feuer E.J.
        • Midthune D.N.
        Permutation tests for joinpoint regression with applications to cancer rates [published correction appears in Stat Med. 2001;20(4):655].
        Stat Med. 2000; 19: 335-351
        • Kim H.-J.
        • Luo J.
        • Chen H.-S.
        • et al.
        Improved confidence interval for average annual percent change in trend analysis.
        Stat Med. 2017; 36: 3059-3074
        • Clegg L.X.
        • Hankey B.F.
        • Tiwari R.
        • Feuer E.J.
        • Edwards B.K.
        Estimating average annual per cent change in trend analysis.
        Stat Med. 2009; 28: 3670-3682
        • Gammie J.S.
        • Sheng S.
        • Griffith B.P.
        • et al.
        Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database.
        Ann Thorac Surg. 2009; 87: 1431-1437
        • Zhou S.
        • Egorova N.
        • Moskowitz G.
        • et al.
        Trends in MitraClip, mitral valve repair, and mitral valve replacement from 2000 to 2016.
        ([published online ahead of print January 22, 2020]. J Thorac Cardiovasc Surg)
        • Panaich S.S.
        • Arora S.
        • Badheka A.
        • et al.
        Procedural trends, outcomes, and readmission rates pre- and post-FDA approval for MitraClip from the National Readmission Database (2013-14).
        Catheter Cardiovasc Interv. 2018; 91: 1171-1181
        • Chhatriwalla A.K.
        • Vemulapalli S.
        • Szerlip M.
        • et al.
        Operator experience and outcomes of transcatheter mitral valve repair in the United States.
        J Am Coll Cardiol. 2019; 74: 2955-2965
        • Schranz A.J.
        • Fleischauer A.
        • Chu V.H.
        • Wu L.-T.
        • Rosen D.L.
        Trends in drug use-associated infective endocarditis and heart valve surgery, 2007 to 2017: a study of statewide discharge data.
        Ann Intern Med. 2019; 170: 31-40
        • US Census Bureau
        Projected age groups and sex composition of the population: main projections series for the United States, 2017-2060. Washington, DC: US Census Bureau, Population Division; 2018.
        (Updated September 2018. Accessed Decemeber 3, 2019)
        • Avierinos J.-F.
        • Inamo J.
        • Grigioni F.
        • Gersh B.
        • Shub C.
        • Enriquez-Sarano M.
        Sex differences in morphology and outcomes of mitral valve prolapse.
        Ann Intern Med. 2008; 149: 787-795
        • Johnston A.
        • Mesana T.G.
        • Lee D.S.
        • Eddeen A.B.
        • Sun L.Y.
        Sex differences in long-term survival after major cardiac surgery: a population-based cohort study.
        J Am Heart Assoc. 2019; 8: e013260
        • Vassileva C.M.
        • McNeely C.
        • Mishkel G.
        • Boley T.
        • Markwell S.
        • Hazelrigg S.
        Gender differences in long-term survival of Medicare beneficiaries undergoing mitral valve operations.
        Ann Thorac Surg. 2013; 96: 1367-1373
        • Song H.K.
        • Grab J.D.
        • O'Brien S.M.
        • Welke K.F.
        • Edwards F.
        • Ungerleider R.M.
        Gender differences in mortality after mitral valve operation: evidence for higher mortality in perimenopausal women.
        Ann Thorac Surg. 2008; 85: 2040-2044
        • Vasan R.S.
        • Larson M.G.
        • Levy D.
        • Evans J.C.
        • Benjamin E.J.
        Distribution and categorization of echocardiographic measurements in relation to reference limits: the Framingham Heart Study; formulation of a height- and sex-specific classification and its prospective validation.
        Circulation. 1997; 96: 1863-1873
        • McNeely C.
        • Vassileva C.
        Mitral valve surgery in women: another target for eradicating sex inequality.
        Circ Cardiovasc Qual Outcomes. 2016; 9: S94-S96
        • Tanguturi V.K.
        • Hidrue M.K.
        • Picard M.H.
        • et al.
        Variation in the echocardiographic surveillance of primary mitral regurgitation.
        Circ Cardiovasc Imaging. 2017; 10: e006495
        • Nishimura R.A.
        • Otto C.M.
        • Bonow R.O.
        • et al.
        ACC/AHA Task Force Members. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published corrections appear in Circulation. 2014;129(23):e651 and Circulation. 2014;130(13):e120].
        Circulation. 2014; 129: e521-e643
        • Kang D.-H.
        • Park S.-J.
        • Shin S.-H.
        • et al.
        Angiotensin receptor neprilysin inhibitor for functional mitral regurgitation.
        Circulation. 2019; 139: 1354-1365