What question did this study set out to answer?

To investigate the long-term clinical outcomes and prognostic factors in elderly patients with symptomatic severe aortic stenosis who refused aortic valve replacement.

October 10, 2018Sunhwan'giOpen Access

Long-term Survival in Korean Elderly Patients with Symptomatic Severe Aortic Stenosis Who Refused Aortic Valve Replacement

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Symptomatic severe aortic stenosis (n=1174). Intervention: Conservative medical treatment (refusal of aortic valve replacement) vs. Age- and sex-matched normal controls. Primary outcome: 5-year all-cause mortality (p=0.014).

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Key result

Elderly patients with symptomatic severe aortic stenosis who refused aortic valve replacement and received conservative treatment had a 5-year all-cause mortality rate of 56.5%, significantly higher than the 25.7% observed in matched controls.

Why the study?

Does conservative medical management affect long-term mortality in elderly patients with symptomatic severe aortic stenosis compared to age- and sex-matched normal controls?

Population

180 elderly patients with symptomatic severe aortic stenosis who refused aortic valve replacement, in Korea.

Comparison

Conservative medical treatment vs Age- and sex-matched normal controls from…

Design

Cohort

Follow-up

39.1±31.0 months

Authors

JOJin Kyung OhChungnam National University JPJae‐Hyeong ParkCardiac Imaging JHJin Kyung HwangElectrophysiology

Discussion

Member takes

Implication

Medically managed elderly severe symptomatic AS patients show high mortality; hypothesis-generating for shared decisions, needs prospective confirmation.

Key Points

To investigate the long-term clinical outcomes and prognostic factors in elderly patients with symptomatic severe aortic stenosis who refused aortic valve replacement.
Analyzed N=180 elderly patients (mean age 78±7 years) diagnosed with symptomatic severe aortic stenosis who refused aortic valve replacement between January 2005 and December 2016.
Assessed long-term clinical outcomes over a mean follow-up period of 39.1±31.0 months.
Evaluated univariate and multivariate prognostic factors associated with all-cause and cardiac mortality.
All-cause mortality rates at 1, 3, and 5 years were 21.1±3.0%, 43.1±3.8%, and 56.5±4.2%, respectively.
Cardiac mortality rates at 1, 3, and 5 years reached 18.0±2.9%, 38.2±3.8%, and 50.7±4.3%, respectively.
Multivariate analysis identified advanced age and anemia as independent significant prognostic predictors for both cardiac and all-cause mortality.

Study Design

Type

Observational (n=1,174)

Multicenter

Yes

Structured PICO

Does conservative medical management affect long-term mortality in elderly patients with symptomatic severe aortic stenosis compared to age- and sex-matched normal controls?

Population

180 elderly patients (mean age 78 years) with symptomatic severe aortic stenosis who refused aortic valve replacement and 994 age- and sex-matched controls, followed for a mean of 39.1 months.

Exposure

Conservative medical treatment (refusal of aortic valve replacement)

Comparator

Age- and sex-matched normal controls from national health examination (5 times more than study population, n=994)

Outcome

All-cause mortality and cardiac mortality during follow-up period (mean 39.1±31.0 months)hard clinical

Main Result

Absolute Event Rate: 56.5% vs 25.7%

p-value: p=0.014

Elderly patients with symptomatic severe aortic stenosis who refuse aortic valve replacement have a poor long-term prognosis, with a 5-year all-cause mortality rate of 56.5%, highlighting the need for prompt interventions like TAVR.

Limitations

Retrospective design with potential selection bias and missing hospitalization data.
Prevalence of coronary artery disease might be underestimated as only 42.2% of patients underwent coronary evaluation.
Did not include outcomes of patients who underwent surgical or percutaneous aortic valve replacement for direct comparison.
Lack of data regarding medical costs compared to surgical or transcatheter interventions.
Retrospective study with review of medical records and data from the Ministry of Public Administration and Security, leading to potential selection bias and missing hospitalization data.
Prevalence of CAD might be underestimated because only 42.2% underwent coronary evaluation.
Did not include outcomes of patients who underwent surgical or percutaneous AVR.
No data about the medical cost of patients undergoing surgical AVR or TAVR versus medical treatment only.

Cite This Study

Oh et al. (2018) conducted an observational in Symptomatic severe aortic stenosis (n=1,174). Conservative medical treatment (refusal of aortic valve replacement) vs. Age- and sex-matched normal controls was evaluated on 5-year all-cause mortality (p=0.014). Elderly patients with symptomatic severe aortic stenosis who refused aortic valve replacement and received conservative treatment had a 5-year all-cause mortality rate of 56.5%, significantly higher than the 25.7% observed in matched controls.

synapsesocial.com/papers/6a7720cfd3a6aa87c6bd95f6 https://doi.org/10.4070/kcj.2018.0208

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Implication

Medically managed elderly severe symptomatic AS patients show high mortality; hypothesis-generating for shared decisions, needs prospective confirmation.

Long-term Survival in Korean Elderly Patients with Symptomatic Severe Aortic Stenosis Who Refused Aortic Valve Replacement

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Long-term Survival in Korean Elderly Patients with Symptomatic Severe Aortic Stenosis Who Refused Aortic Valve Replacement

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

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