Why are peo­ple with valvu­lar heart dis­ease in Sau­di Ara­bia not get­ting treat­ed?

Effec­tive treat­ment is avail­able, yet – despite a grow­ing old­er pop­u­la­tion in Sau­di Ara­bia – very few peo­ple receive aor­tic valve replace­ment annu­al­ly.

The low num­ber of patients treat­ed annu­al­ly in Sau­di Ara­bia hints at missed oppor­tu­ni­ties and gaps in patient care, caus­ing unde­tect­ed and insuf­fi­cient­ly treat­ed degen­er­a­tive VHD. A mod­el was devel­oped to esti­mate the bur­den of severe symp­to­matic aor­tic steno­sis in the local pop­u­la­tion, using mar­ket-relat­ed data on treat­ment to bet­ter under­stand where patients “drop off” along the care path­way (Fig­ure 3).

The patient drop-off demon­strates the urgent need for improve­ments in the health sys­tem to ensure that all patients with aor­tic steno­sis receive the care they require.

Fig­ure 3: The drop-off of patients with severe symp­to­matic aor­tic steno­sis indi­cates the need for improved aware­ness, detec­tion, and diag­no­sis in Sau­di Ara­bia

Missed oppor­tu­ni­ties

Patients and their fam­i­lies fail to seek help, as they believe that their symp­toms relate to nat­ur­al aging.

The patient’s doc­tor or PCP fails to per­form aus­cul­ta­tion, thus miss­ing the oppor­tu­ni­ty to diag­nose aor­tic steno­sis dur­ing a con­sul­ta­tion.

The PCP per­forms the aus­cul­ta­tion but does not refer the patient to a spe­cial­ist to con­firm the sus­pect­ed diag­no­sis.

Around

20,000

peo­ple over the age of 65 years are esti­mat­ed to live with symp­toms of severe aor­tic steno­sis in Sau­di Ara­bia.*

Each year, around

1,900

Patients are referred by PCPs for diag­no­sis of a sus­pect­ed heart mur­mur.** This indi­cates that a sig­nif­i­cant pro­por­tion of symp­to­matic severe aor­tic steno­sis patients liv­ing with symp­toms go unno­ticed, or are not rec­og­nized as hav­ing VHD, or remain unde­tect­ed by their doc­tor.21

Only

1,500

* Cal­cu­lat­ed based on pub­lished pop­u­la­tion fig­ures (≥ 65 years Sau­di nation­al­s/non-nation­als) and glob­al preva­lence data.46,47 A preva­lence range of 1.7% to 2.6% has been fac­tored into the analy­ses as a plau­si­ble esti­mate based on avail­able lit­er­a­ture. How­ev­er, this range like­ly under­es­ti­mates the true preva­lence with­in the Sau­di pop­u­la­tion. This under­es­ti­ma­tion is due to the high preva­lence of comor­bidi­ties such as hyper­ten­sion, dys­lipi­demia, dia­betes, and obe­si­ty in Sau­di Ara­bia, which are known to con­tribute to accel­er­at­ed cal­ci­fi­ca­tion of the aor­tic valve. Pop­u­la­tion-based epi­demi­o­log­i­cal stud­ies are crit­i­cal to obtain more accu­rate esti­mates on the preva­lence of severe aor­tic steno­sis in Sau­di Ara­bia. ** These esti­mates have been cal­cu­lat­ed based on expert opin­ion.

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