Therapeutic decisions for patients with symptomatic severe aortic stenosis: room for improvement?

Geldorp, Martijn W.A. van; Gameren, Menno van; Kappetein, Arie Pieter; Arabkhani, Bardia; Laat, Lotte E. de Groot–de; Takkenberg, Johanna J.M.; Bogers, Ad J.J.C.

doi:10.1016/j.ejcts.2009.01.043

Cited by 51 publications

(44 citation statements)

References 20 publications

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“…Nevertheless, at least one third of patients with symptomatic AS do not undergo AVR although they have a clear indication [7][8][9][10]. Advanced age, poor left ventricular function, and comorbidities are common reasons for nonreferral for AVR [8,9,[11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Clinical course of patients diagnosed with severe aortic stenosis in the Rotterdam area: insights from the AVARIJN study

et al. 2012

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Objective To prospectively evaluate the clinical course of patients with severe aortic stenosis (AS) and identify factors associated with treatment selection and patient outcome. Methods Patients diagnosed with severe AS in the Rotterdam area were included between June 2006 and May 2009. Patient characteristics, echocardiogram, brain natriuretic peptide (NT-proBNP), and treatment strategy were assessed at baseline, and after 6, 12, and 24 months. Endpoints were aortic valve replacement (AVR) / transcatheter aortic valve implantation (TAVI) and death. Results The study population comprised 191 patients, 132 were symptomatic and 59 asymptomatic at study entry. Two-year cumulative survival of symptomatic patients was 89.8 % (95 % CI 79.8-95.0 %) after AVR/TAVI and 72.6 % (95 % CI 59.7-82.0 %) with conservative treatment. Twoyear cumulative survival of asymptomatic patients was 91.5 % (95 % CI 80.8-96.4 %). Two-year cumulative incidence of AVR/TAVI was 55.9 % (95 % CI 47.5-63.5 %) in symptomatic patients. Sixty-eight percent of asymptomatic patients developed symptoms, median time to symptoms was 13 months; AVR/TAVI cumulative incidence was 38.3 % (95 % CI 23.1-53.3 %). Elderly symptomatic patients with multiple comorbidities were more likely to receive conservative treatment. Conclusions In contemporary Dutch practice many symptomatic patients do not receive invasive treatment of severe AS. Two-thirds of asymptomatic patients develop symptoms within 2 years, illustrating the progressive nature of severe AS. Treatment optimisation may be achieved through careful individualised assessment in a multidisciplinary setting.

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Section: Introductionmentioning

confidence: 99%

Clinical course of patients diagnosed with severe aortic stenosis in the Rotterdam area: insights from the AVARIJN study

et al. 2012

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“…We did demonstrate that scores of the SF-36v2™ correspond well with the severity of symptoms according to [19] undergo AVR [10,12,20,23,24]. Exercise testing is highly underused and downgraded from a class 2a to a 2b recommendation in the ACC/AHA guidelines, although it is reported to elicit symptoms in approximately 37 % of patients with aortic stenosis who were previously regarded as 'asymptomatic' [8,25,26].…”

Section: Interpretation and Discussion Of Main Resultsmentioning

confidence: 99%

“…Nonetheless, several studies show that for various reasons many patients who have an indication for aortic valve replacement are denied surgery [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Quality of life among patients with severe aortic stenosis

et al. 2012

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Background The disease burden of patients with severe aortic stenosis is not often explored, while the incidence is increasing and many patients who have an indication for aortic valve replacement are not referred for surgery. We studied the quality of life of 191 patients with severe aortic stenosis, hypothesising that symptomatic patients have a far worse quality of life than the general population, which could enforce the indication for surgery. Methods The SF-36v2 Health Survey was completed by 191 consecutive patients with symptomatic or asymptomatic severe aortic stenosis.

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“…Similar models have been developed for prediction of prognosis after aortic valve replacement. 6,36, 37 Because the research described has been used for the development of new guidelines in the field of aortic valve replacement, 38 it has had direct consequences for clinical practice. Both the choice of treatment by physicians and the quality of life of patients have improved.…”

Section: Microsimulation In Stable Cadmentioning

confidence: 99%

Microsimulation for Clinical Decision-Making in Individual Patients With Established Coronary Artery Disease

Battes

Kardys

Barendse

et al. 2013

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Therapeutic decisions for patients with symptomatic severe aortic stenosis: room for improvement?

Cited by 51 publications

References 20 publications

Clinical course of patients diagnosed with severe aortic stenosis in the Rotterdam area: insights from the AVARIJN study

Clinical course of patients diagnosed with severe aortic stenosis in the Rotterdam area: insights from the AVARIJN study

Quality of life among patients with severe aortic stenosis

Microsimulation for Clinical Decision-Making in Individual Patients With Established Coronary Artery Disease

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