190 According to observational studies 187 , 191 and the GBD 2021 data, 186 in Brazil, as well as in the rest of the world, an increasing trend towards degenerative aortic valve disease has been observed in areas where the epidemiological transition and changes in age composition have evolved, as compared to other etiologies, such as RHD. 192 Mortality •Valvular heart disease is one of the leading causes of cardiovascular death in Brazil, particularly in economically underserved regions, RHD being the most socially driven etiology.
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Hospitalizations for clinical conditions showed a trend to decrease in the last decades, while those related to procedures or surgical interventions increased during this period ( Tables 1-4 and 1-5 ). 49 Ischemic heart diseases, cerebrovascular diseases, cardiac failure, and arrhythmia accounted for 68% of all cardiovascular disease hospital admissions ( Table 1-4 ). 49 •The number of hospital admissions for CVDs after the year 2020 showed a significant reduction in all Brazilian regions, as depicted in Chart 1-6 .