Nicholas Jones (United Kingdom)
University of Oxford
Nuffield Department of Primary Care Health Sciences
Nick is a Wellcome Trust Doctoral Research Fellow and DPhil student in the Nuffield Department of Primary Care Health Sciences, University of Oxford. His main research interest is treatment and outcomes for patients with comorbid cardiovascular disease, particularly atrial fibrillation and heart failure. His DPhil thesis is looking at the stroke risk of these conditions in combination using a large database of routine primary care data and a linked decision modelling study to identify cost effect approaches to improving anticoagulation and stroke prevention. This research compliments Nick’s clinical work as a GP in a central Oxford teaching practice and as a GP Cardiologist providing outpatient care at Oxford University Hospitals. Nick’s other research interests include systematic reviews, digital health and clinical trials. He is currently contributing towards two large randomised trials, one of atrial fibrillation screening (AMALFI) in the community and a second of spironolactone in chronic kidney disease (BARACK-D). Nick is an author on the Essential Knowledge Update programme run by the Royal College of General Practitioners and is involved in undergraduate medical student education at the University of Oxford.

Presenter of 1 Presentation

 Conference Calendar

SURVIVAL OF PEOPLE WITH VALVULAR HEART DISEASE IN THE COMMUNIT: A PROSPECTIVE COHORT STUDY

Session Name
0170 - CARDIOMETABOLIC DISEASE (ID 18)
Date
07.07.2021, Wednesday
Session Time
05:30 PM - 07:00 PM
Room
Hall 2
Presenter
Lecture Time
05:30 PM - 05:41 PM
Session Icon
Pure Live

Abstract

Abstract Body

Background and purpose: Over 50% of people aged >65 years have some degree of valvular heart disease (VHD), though most is mild. To understand the prognostic significance of VHD, we investigated its association with all-cause and cause-specific mortality.

Methods: The Oxford Valvular Heart Disease cohort study screened 4,009 participants aged >65 years between 2009-2016 to establish the presence and severity of VHD. We linked data to a civil mortality registry and undertook analysis using Kaplan-Meier curves, log rank tests, Cox regression and a Fine-Gray competing risks model.

Results: Data linkage was available for 3,511 participants, of whom 361 (10.3%) died (median 6.49 years follow-up). Valve abnormalities were common (n=2,645, 70.2%), though most was mild (prevalence 44.9%). Only 5.2% had clinically significant VHD. In adjusted analyses, neither mild nor clinically significant VHD were associated with increased all-cause mortality (HR 1.20, 95%CI: 0.96-1.51 and HR 1.47, 95%CI: 0.94-2.31 respectively). Conversely, advanced aortic sclerosis (prevalence 2.25%) and mitral annular calcification (MAC) (1.31%) were associated with an increased risk of death (HR 2.05, 95%CI: 1.28-3.30 and HR 2.51, 95%CI: 1.41-4.49 respectively). Mortality was highest for people with both advanced aortic sclerosis or MAC and clinically significant VHD (HR 4.38, 95%CI: 1.99-9.67).

Conclusions: The presence of advanced aortic sclerosis and MAC confers a worse outcome, particularly for patients with significant VHD, suggesting atherosclerosis is an important driver of mortality. Older patients with mild VHD can be reassured about their prognosis. The absence of an association between significant VHD and mortality may reflect the low disease prevalence.

Hide