Introduction Despite valvular heart disease (VHD) being a major contributor to cardiovascular health issues globally, limited epidemiological data exist for Malaysia.

Objective To examine the incidence, characteristics, and reasons behind treatment refusal in VHD.

Methods A cross-sectional, multi-centre study was conducted in Perak, Malaysia, using echocardiography data collected over six months to evaluate newly diagnosed VHD patients. Demographics, symptoms, aetiology, and disease severity were assessed.

Results Echocardiography data from 12,610 patients revealed a 7.5% incidence of VHD. Mitral regurgitation (MR) was the most common, accounting for 34.1%, followed by tricuspid regurgitation (TR) at 32.3% and aortic regurgitation (AR) at 19.2%. Aortic stenosis (AS) and mitral stenosis (MS) were less frequent, at 5.6% and 1.6%, respectively. Most VHD cases were mild (65.6%), followed by moderate (29.2%) and severe (5.1%). The median age was 67, with a slight female majority, and the median LVEF was 57%. While 32.6% were asymptomatic, dyspnoea was the most common symptom (48.8%). Overall, pulmonary hypertension was present in 35.3%, whereas atrial fibrillation (AF) was found in 12.2%. In terms of aetiology, the most common overall was functional aetiology (59%). Rheumatic heart disease (RHD) affected 51.7% of MS cases, while degenerative aetiology was the main cause for AR (74.9%), AS (84.6%), and primary MR (71.4%). Both TR and pulmonary regurgitation (PR) were predominantly due to functional aetiology at 98% and 99%, respectively. Although RHD constituted only 6.2% of all VHD cases, it affected the mitral valve in 56.1%, with over half (52.6%) of RHD cases being moderate or severe. AS was strongly associated with hypertension and dyslipidaemia (p < 0.05), while TR was more common in females (p < 0.05). MR had strong associations with AF, chronic kidney disease (CKD), and ischemic heart disease (IHD) (p < 0.05), with MR being the most common valve lesion in AF (34.3%), CKD (36.4%), and IHD (35.8%). Despite 6.7% of patients requiring valve intervention, only 24.2% agreed to proceed (p < 0.001). The majority (36.3%) refused, primarily due to old age (62.5%) and fear of surgery (29.2%), while 39.4% were undecided. Multiple valves were involved in 72.6% of cases, with MR + TR being the most frequent combination (52.5%), primarily due to functional aetiology (75.2%).

Conclusion The incidence of VHD was 7.5%, with functional mitral regurgitation (MR) being the most common valve lesion. Patients primarily refused valve intervention due to old age. This study provides valuable insights into VHD in Malaysia.