Ageism Kills: The Case of Heart Valve Disease

by Michael W. Hodin

Ageism can come in many forms, from social to economic to political, but at its worst, ageism can prove deadly. If you were 63 and lost your job during Covid-19, it’s very likely you left the workforce because you couldn’t find employment. A 70-year-old woman shopping may well be directed to “a certain style.” But if you’re 74 with symptoms like shortness of breath, fatigue, dizziness, and chest pain, even your doctor will too often dismiss your symptoms as “just a normal part of getting old,” ignoring that these symptoms can likely be early signs of heart valve disease (HVD).

For HVD, these ageist assumptions impede detection, slow the path to diagnosis, and limit a person’s ability to access effective interventions. In short: unchecked, ageism approaches to medicine can kill you. When untreated, severe, symptomatic aortic stenosis (the most common type of heart valve disease) has a mortality rate between 25 and 50 percent per year. Even mild and moderate aortic stenosis are also associated with a higher mortality risk than previously suspected, underlining the necessity of early diagnosis and treatment.

“Ageism is an important social determinant of health largely neglected until now,” wrote Christopher Mikton, Alana Officer, Vania de la Fuente-Nunez and Etienne Kru. “The social determinants of health are the non-medical factors that influence health outcomes and include the conditions in which people are born, grow up, and live and the wider set of forces and systems that shape the conditions of daily life.”

In fact, a Global Coalition on Aging-Global Heart Hub position paper built on a prominent roundtable of experts to examine how behavior and policy change can best address HVD in our 21st century. Our paper’s main actions and policy recommendations will help us change how we deal with heart valve disease, ultimately saving lives and conserving resources. In the US alone, HVD costs $235 billion each year in direct health expenditures. Over a ten-year period, without timely access to treatment, it’s estimated that $10 billion would be lost from contributions like volunteering and family caregiving.

Our response to HVD can show what’s possible for innovation in healthy aging – but we must drive implementation for scale. Medical advances and health innovations have significantly expanded earlier detection and diagnosis as well as treatment options, offering effective interventions to address this debilitating, life-threatening disease.

However, greater urgency is needed to ensure that patients and families, health systems, and societies reap the full benefits of these innovations. This will happen only if:

· There is greater global awareness across stakeholder disciplines;

· Health systems respond with equitable access, reimbursement, and encouragement for the use of innovations; and

· HVD is recognized as a central element of the Decade of Healthy Ageing.

Progress will require greater collaboration and commitment across disciplines, sectors, and countries. A coalition of patients, caregivers, general practitioners, cardiologists, cardiac surgeons, and advocates can lead these efforts – working with governments, health systems, and payers to ensure people are receiving the care they deserve.

Whether at the workplace, in fashion and design, or even in healthcare, ageism has an insidious impact on how we live our lives, grow our economy, and manage sustainable health systems. Heart valve disease demonstrates the consequences of an ageist society, but it also shows us what’s possible if we can change that culture.