Aortic valve disease in the older adult

As the population continues to age, aortic stenosis remains as the most prevalent valvular disease in Western countries. The number of elderly patients with aortic stenosis continues to pose both a diagnostic and therapeutic challenge. Despite new advances such as transcatheter aortic valvular replacement (TAVR), there is still much patient-provider decision making that needs to take place given the comorbidities and complex goals of care in an elderly patient population. The increased longevity due to advances in health care has resulted in an increase in diagnosis of aortic stenosis. While the prevalence is low in patients < 60 years of age, it increases to approximately 10% in patients > 80 years of age. The severity of aortic stenosis increases with age, with one in eight people older than age 75 showing moderate to severe aortic stenosis. This represents a significant health care burden that is projected to increase as the population progressively ages. Age related, or degenerative valvular heart disease, represents the most common etiology of aortic stenosis in the elderly population. Degenerative aortic valve disease affects over 25% of all patients over the age of 65. Most patients have only mild thickening and normal valve function, called aortic sclerosis. However, 2%–5% of these patients have significant aortic stenosis with obstruction of left ventricular outflow. Clinical risk factors for degenerative aortic valve stenosis mirror those associated with coronary atherosclerosis. Tra-