Heart Valve Disease Mortality Reverses Course in Older U.S. Adults
Deaths from heart valve disease among U.S. adults 65 and older are rising again after years of steady improvement, with mortality rates climbing from 2018 through 2023 and projected to remain elevated through 2040. The pattern is especially troubling because it appears after nearly two decades of decline, suggesting that population aging, delayed diagnosis and uneven access to specialized valve care are colliding at the same time.
The analysis, set to be presented at American Heart Association Scientific Sessions 2026, examined national mortality data from 1999 through 2023 and focused on adults 65 and older. More than 1.2 million valve-related deaths were identified over that span. Death rates fell from 123.2 per 100,000 in 1999 to their lowest levels just before the pandemic period, then turned upward and reached 109.2 per 100,000 in 2023. The projected trajectory through 2040 does not return to the earlier decline; instead, it stays near the current elevated level.
A single trend line captures the concern: mortality improved, then stalled, then began climbing again.
Older Age, Male Sex and Rural Residence Carry the Heaviest Burden
The burden is not evenly distributed. Men had higher valvular heart disease death rates than women, 124.7 versus 103.1 per 100,000. Non-Hispanic white adults had the highest mortality rate among the racial and ethnic groups included, at 122.4 per 100,000. Nonmetropolitan areas also carried greater mortality than metropolitan areas, 120.5 versus 110.1 per 100,000.
Age remained the most powerful marker of risk. Adults 85 and older had more than 15 times the death rate from valvular heart disease compared with adults ages 65 to 69 in 1999, when overall mortality was at its highest. Even more concerning, newer generations showed some improvement in their late 60s, but those gains did not persist into very old age. By age 85 and older, newer generations experienced higher mortality than earlier generations did at the same age.
That pattern fits the biology of valve disease in older adults. Calcific aortic stenosis, degenerative mitral disease and other age-related valve disorders often progress silently for years before symptoms prompt evaluation. By the time dyspnea, syncope or heart failure appear, disease may already be advanced and the window for optimal intervention may have narrowed. In rural areas, where access to echocardiography, valve specialists and structural heart programs may be limited, the path from symptoms to diagnosis can stretch even longer.
Why the Mortality Curve Matters for Bedside Care
The findings point to a stubborn mismatch between therapeutic progress and population-level outcomes. Over the past decade and a half, valve intervention has advanced substantially, with earlier recognition, transcatheter options and more refined surgical care. Yet the mortality curve moved in the opposite direction after 2018, suggesting that innovation alone does not guarantee timely treatment for the people who need it most.
The study does not measure valve severity, echocardiographic findings or individual treatment histories, so it cannot explain exactly why mortality rose. Death-certificate data also cannot separate undiagnosed disease from untreated disease or from complications in patients who never reached specialty care. Still, the broad signal is hard to ignore: a disease that should be increasingly manageable in an aging health system is still killing more older adults.
For clinicians, the practical consequence is earlier suspicion. Unexplained exertional dyspnea, reduced exercise tolerance, new murmurs, presyncope, edema and recurrent heart failure admissions in older adults should prompt evaluation for valve disease rather than being attributed automatically to deconditioning or nonspecific aging. In communities with fewer specialty resources, referral pathways matter as much as the diagnosis itself.
Mortality Data Suggest a Need for Faster Detection and Wider Access
The research team used U.S. Centers for Disease Control and Prevention WONDER mortality records, identified valve-related deaths through ICD-10 coding and applied joinpoint regression, age-period-cohort analysis and ARIMA forecasting through 2040. Those methods strengthen the trend analysis, but they also leave the usual limits of administrative mortality data in place. Cause-of-death coding can be inaccurate, and death certificates do not capture disease severity or the timing of intervention.
Even with those constraints, the epidemiologic signal aligns with current concerns in cardiovascular care. The older the population gets, the more likely valve disease is to become a dominant contributor to heart failure, frailty and death. When the rise is steepest in men, older adults and nonmetropolitan communities, prevention strategies cannot remain generic. They need to be targeted toward earlier recognition, faster imaging and more reliable access to specialized valve teams.
Sreekanth Vemulapalli, who is affiliated with Duke University and the Duke Clinical Research Institute, described the reversal in mortality as alarming given the treatment gains of recent years. The disconnect between clinical innovation and real-world outcomes points to a health-system problem as much as a disease problem. Earlier detection is not a slogan here; it is the difference between elective evaluation and late-stage rescue.
The abstract is preliminary and has not yet undergone peer review. Even so, the trajectory through 2040 raises an uncomfortable question for U.S. cardiovascular care: whether an aging population will outpace the system’s ability to find and treat valve disease before it becomes fatal.