About Structural Heart Diseases

Structural Heart Diseases (SHDs) are structural abnormalities of the heart leading to impaired functioning1. They are forms of cardiovascular disease and include heart valve diseases such as aortic stenosis and mitral or tricuspid regurgitation that require valve repair or replacement. The disease is linked to functional decline and mostly affects the elderly. Congenital structural heart disease also exists and occur when heart’s valves do not develop before birth. Sometimes the defect keeps the valve from closing completely, which means blood can flow back into the heart. The prevalence is smaller than the SHDs linked to functional decline. This is why the information on this website is mostly focused on age-related SHDs linked to functional decline. 

It is estimated that SHDs currently affect 14 million people in Europe, a significant proportion of whom also suffer from suspected heart failure. In the last 20 years the number of hospitalisations due to SHD has doubled. With Europe’s ageing population, this means that in 2040 more than 20 million people will suffer from this disease.

The heart valves

The heart has four valves that keep blood flowing in one direction through the heart. These are the aortic, mitral, tricuspid and pulmonary valves. Heart valve disease happens when at least one of the four valves fails to work as it should. The most common forms of heart valve disease in Europe are mitral valve regurgitation, aortic stenosis, and tricuspid valve disease.

What happens when you suffer from a structural heart disease: two examples

Normal

The Valve fully opens & closes.

Mitral Regurgitation

The valve doesn't fully close & leaks.

Aortic Stenosis

The valve doesn't open enough.

Signs and symptoms

Fatigue
Difficulty exercising
Palpitation
Chest pain
Shortness of breath
Fainting

Did you know?

Europe is greying. In 2050, 1 European out of 3 will be over 65 – 150M in total.

At 65, half of a person’s remaining life years will be characterised by health complaints.

Old-age dependancy is increasing

The prevalence of SHDs is increasing with age

In 2050 the EU will have an estimated 23M people over 65 with SHD.

Cardiovascular diseases (incl. SHDs) are the number 1 co-morbidity in COVID-19 deaths in Europe

For patients with severe symptomatic aortic stenosis, without repair or replacement

Detection and treatment of Cardiovascular and Structural Heart Diseases are still strongly linked to health inequalities (gender, geographic, social)

References

  1. Eurostat (2017) People in the EU – population projections, http://ec.europa.eu/eurostat/statistics-explained/index.php?title=People_in_the_EU_-_population_projections [retrieved on: 25/July/2018]
  2. The old age dependency ration is defined as the ratio between the number of persons aged 65 years and over to the number of persons aged 15-64, expressed as a percentage.
  3. Eurostat (2017) Baseline projections: demographic balances and indicators, http://appsso.eurostat.ec.europa.eu/nui/submitViewTableAction.do [retrieved on 31/July/2018]
  4. Figures extrapolated based on projected demographic figures from Eurostat and the burden of Structural Heart Diseases provided in the OxVALVE Population Cohort Study.
  5. WHO Europe (2020) http://www.euro.who.int/fr/health-topics/health-emergencies/-coronavirus-covid-19/weekly-surveillance-report 
  6. Summary of a Report From 72 314 Cases From the Chinese Center for Disease Control and Prevention Published online: February 24, 2020. doi:10.1001/jama.2020.2648
  7. Daniel H. Steinberg, Stephan Staubach, Jennifer Franke, Horst Sievert, Defining structural heart disease in the adult patient: current scope, inherent challenges and future directions, European Heart Journal Supplements, Volume 12, Issue suppl_E, 1 September 2010, Pages E2–E9, https://doi.org/10.1093/eurheartj/suq012
  8. Spaccarotella C et al. Pathophysiology of Aortic Stenosis and Approach to Treatment With Percutaneous Valve Implantation. Circulation Journal. 2011; 75: 11-19
  9. https://ourworldindata.org/mortality-risk-covid
  10. https://www.bmj.com/content/bmj/370/bmj.m3259.full.pdf
  11. Bhattacharyya S, Lloyd G. Mortality whilst waiting for intervention in symptomatic severe aortic stenosis. European Heart Journal - Quality of Care and Clinical Outcomes 2020; 6, (1): 89–90
  12. Malraisie S, et al. Mortality While Waiting for Aortic Valve Replacement. Ann Thorac Surg 2014;98:1564–71