Clinical Outcomes According to Aortic Stenosis Management: Insights From Real-World Practice.

Autor: Coisne A; Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille Lille France.; Cardiovascular Research Foundation New York City NY USA., Montaigne D; Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille Lille France., Aghezzaf S; Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille Lille France., Ninni S; Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille Lille France., Lemesle G; Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille Lille France.; Heart and Lung Institute, University Hospital of Lille Lille France.; Univ. Lille Paris France.; Institut Pasteur of Lille, Inserm U1011 Lille France.; FACT (French Alliance for Cardiovascular Trials) Paris France., Sudre A; Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille Lille France.; Heart and Lung Institute, University Hospital of Lille Lille France.; Univ. Lille Paris France.; Institut Pasteur of Lille, Inserm U1011 Lille France.; FACT (French Alliance for Cardiovascular Trials) Paris France., Lamblin N; Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille Lille France., Modine T; UMCV, Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux Pessac France., Vincentelli A; Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille Lille France., Juthier F; Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille Lille France., Leon MB; Cardiovascular Research Foundation New York City NY USA., Granada JF; Cardiovascular Research Foundation New York City NY USA., Bauters C; Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille Lille France.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2024 Nov 19; Vol. 13 (22), pp. e036657. Date of Electronic Publication: 2024 Nov 15.
DOI: 10.1161/JAHA.124.036657
Abstrakt: Background: Real-world data regarding clinical outcomes according to aortic stenosis (AS) management are scarce. Therefore, we aimed to investigate long-term management across the spectrum of outpatients with AS.
Methods and Results: Between May 2016 and December 2017, consecutive outpatients with mild (peak aortic velocity, 2.5-2.9 m/s), moderate (3-3.9 m/s), and severe AS (≥4 m/s) were included by 117 cardiologists in the VALVENOR (Follow-Up of a Cohort of Patients With Valvular Aortic Stenosis in the Nord-pas-de-Calais Region) study and followed-up for aortic valve replacement (AVR) and modes of death. Among 2704 patients included, 1156 (42.7%) had mild, 1121 (41.5%) moderate, and 427 (15.8%) severe AS. After a median follow-up of 5 years, 993 AVRs (488 surgical and 505 transcatheter) and 1098 deaths occurred. The 5-year cumulative incidence of AVR or of the composite of death or AVR was 13.3% and 45.2% in mild AS, 45.5% and 75.3% in moderate AS, and 62.8% and 90.6% in severe AS, respectively. Of the 292 patients who met the criteria for AVR but were not treated, AVR was considered futile in 137 patients and 155 patients refused AVR. Mortality rates after 3 years were high: 86% for anticipated futility and 72.3% for refusal. While patients at anticipated futility showed a well-balanced proportion of cardiovascular and noncardiovascular deaths, cardiovascular deaths predominated among those who refused AVR.
Conclusions: At 5-year follow-up, only two thirds of patients with severe AS underwent AVR. Patients with untreated severe AS experienced high mortality rates, mostly cardiovascular for patients who declined AVR. This advocates for better patient education based on shared decision making and for optimizing AS quality of care, from diagnosis to treatment.
Databáze: MEDLINE
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