Aortic valve replacement was not performed in 43.2% of ambulatory patients with severe aortic stenosis, despite AVR being associated with an average of 85.8 days of life gained at 730 days.
Cohort (n=324)
Does aortic valve replacement improve mortality in ambulatory patients with severe aortic stenosis?
A significant proportion of patients with severe aortic stenosis do not receive indicated AVR, particularly those who are older, have more comorbidities, or have low-gradient AS, despite a clear survival benefit.
Effect estimate: 85.8 days of life gained (95% CI 40.9-130.6)
Background Many patients with severe aortic stenosis (AS) and an indication for aortic valve replacement (AVR) do not undergo treatment. The reasons for this have not been well studied in the transcatheter AVR era. We sought to determine how patient‐ and process‐specific factors affected AVR use in patients with severe AS. Methods and Results We identified ambulatory patients from 2016 to 2018 demonstrating severe AS, defined by aortic valve area ≤ 1.0 cm 2 . Propensity scoring analysis with inverse probability of treatment weighting was used to evaluate associations between predictors and the odds of undergoing AVR at 365 days and subsequent mortality at 730 days. Of 324 patients with an indication for AVR (79.3±9.7 years, 57.4% men), 140 patients (43.2%) did not undergo AVR. The odds of AVR were reduced in patients aged >90 years (odds ratio OR, 0.24 95% CI, 0.08–0.69; P =0.01), greater comorbid conditions (OR, 0.88 per 1‐point increase in Combined Comorbidity Index 95% CI, 0.79–0.97; P =0.01), low‐flow, low‐gradient AS with preserved left ventricular ejection fraction (OR, 0.11 95% CI, 0.06–0.21), and low‐gradient AS with reduced left ventricular ejection fraction (OR, 0.18 95% CI, 0.08–0.40) and were increased if the transthoracic echocardiogram ordering provider was a cardiologist (OR, 2.46 95% CI, 1.38–4.38). Patients who underwent AVR gained an average of 85.8 days of life (95% CI, 40.9–130.6) at 730 days. Conclusions The proportion of ambulatory patients with severe AS and an indication for AVR who do not receive AVR remains significant. Efforts are needed to maximize the recognition of severe AS, especially low‐gradient subtypes, and to encourage patient referral to multidisciplinary heart valve teams.
Flannery et al. (Fri,) conducted a cohort in Severe aortic stenosis (n=324). Aortic valve replacement vs. No aortic valve replacement was evaluated on Mortality at 730 days (85.8 days of life gained, 95% CI 40.9-130.6). Aortic valve replacement was not performed in 43.2% of ambulatory patients with severe aortic stenosis, despite AVR being associated with an average of 85.8 days of life gained at 730 days.