Nationwide incidence of patients hospitalized for a valvular heart disease according to etiology: Patient characteristics and temporal trends in France 2006–2016

Background The main etiologies of valvular heart disease (VHD) are rheumatic fever and age-related degeneration. In 2016, the prevalence of patients managed for a VHD was 0,6% of the French population (341,500 people). However, few recent incidence data are available in France. Purpose Estimate the annual incidence of patients hospitalized for VHD in France according to their etiology, describe their characteristics and the temporal trends. Methods All patients hospitalized for VHD in France between 2006 and 2016 were identified using data from the national hospital discharge database (PMSI-MCO) integrated into the national health data system (SNDS). The first stay of the year in which the patient was hospitalized with a principal or related diagnosis of VHD was selected. Descriptive analyses of patients’demographic and medical characteristics and trends from 2006–2016 were stratified according to the origin of valvular heart disease. Results In 2016 38,875 patients were hospitalized for a VHD in France. Of these, 89% were hospitalized for non-rheumatic VHD (52.1/100,000 person-year (PY)) with an average age of 74 years; 5% for rheumatic VHD (3.1/100,000 PY) with an average age of 67 years; 3% for congenital VHD (1.1/100,000 PY) with an average age of 29 years; and 3% for unspecified origin. The incidence of patients hospitalized for non-rheumatic VHD increased by 43% between 2006 and 2016, particularly in older patients. It has decreased by 42% for rheumatic VHD. Departmental disparities were observed for these disorders, with a high incidence of hospitalization for rheumatic VHD in the Ile-de-France, the French overseas departments and territories and the south-east. Conclusion The improvement in the management of streptococcal A angina, the increase in life expectancy and the expansion of indications for the management of aortic stenosis and mitral regurgitation by transcatheter valve replacement have reshaped the distribution of types of VHD hospitalized since 2006.