Unnecessary deaths from valvular aortic stenosis

The annual mortality from aortic valvular stenosis was calculated among potential candidates for surgical replacement of the aortic valve. From the Swedish Central Register of Causes of Death, 70 patients below the age of 80 years who had died from aortic stenosis during a 1-year period in the County of Stockholm (population 1.5 million), were identified. A retrospective analysis of their medical records showed that 37 individuals were suitable candidates for surgery. The presence of aortic stenosis had been verified at autopsy in 31 (84%) patients. The remaining six patients (16%) had their aortic stenosis diagnosis established by a thorough non-invasive investigation performed before death. Although typical signs and symptoms of aortic stenosis were recorded in all 37 patients, only six (16%) of them had been considered by their physicians to be suitable candidates for surgery prior to death. The deceased patients were compared with a group of 68 patients who had undergone aortic valve replacement for aortic stenosis during the same period. There were no significant differences between the two groups with regard to symptoms and clinical findings, except for a higher incidence of syncope in the operated group. It is concluded that, of 105 (68 surgically treated and 37 deceased) eligible patients with aortic stenosis, 37 individuals did not receive surgical care in time. The reason for this was probably insufficient knowledge of the curability of the disease.