Heart valve clinic follow-up was associated with reduced all-cause mortality compared with standard of care in moderate and asymptomatic severe aortic stenosis (HR 0.63; 95% CI 0.40-0.98; P=0.038).
Observational (n=2,129)
No
Does a heart valve clinic approach reduce all-cause mortality in patients with moderate and asymptomatic severe aortic stenosis compared to standard of care?
Follow-up in a dedicated multidisciplinary heart valve clinic is associated with reduced all-cause mortality and more efficient management in patients with moderate and asymptomatic severe aortic stenosis compared to routine cardiac care.
Hazard Ratio: 0.63 (95% CI 0.4–0.98)
p-value: p=0.038
BACKGROUND: Heart valve clinics (HVC) have been introduced to manage patients with valvular heart disease within a multidisciplinary team. OBJECTIVE: To determine the outcome benefit of HVC approach compared with standard of care (SOC) for patients with moderate and asymptomatic severe aortic stenosis (mAS and asAS). METHODS: Single-centre, observational registry of patients with mAS and asAS with at least one cardiac ambulatory consultation at our Cardiovascular Centre. Based on the outpatient strategy, patients were divided into HVC group, if receiving at least one visit at HVC, and SOC group, if followed by routine cardiac consultations. RESULTS: 2129 patients with mAS and asAS were divided into those followed in HVC (n=251) versus SOC group (n=1878). The mean age was 76.5±12.4 years; 919 (43.2%) had asAS. During a follow-up of 4.8±1.8 years, 822 patients (38.6%) died, 307 (14.4%) were hospitalised for heart failure and 596 (28%) underwent aortic valve replacement (AVR). After propensity score matching, the number of consultations per year, exercise stress tests, brain natriuretic peptide (BNP) determinations and CTs were higher in the HVC cohort (p<0.05 for all). A shorter time between indication of AVR and less advanced New York Heart Association class was reported in the HVC cohort (p<0.001 and p=0.032). Compared with SOC, the HVC approach was associated with reduced all-cause mortality (HR=0.63, 95% CI 0.40 to 0.98, p=0.038) and cardiovascular death (p=0.030). At multivariable analysis, the HVC remained an independent predictor of all-cause mortality (HR=0.54, 95% CI 0.34 to 0.85, p=0.007). CONCLUSIONS: In patients with mAS and asAS, the HVC approach was associated with more efficient management and outcome benefit compared with SOC.
Paolisso et al. (Mon,) conducted a observational in Moderate and asymptomatic severe aortic stenosis (n=2,129). Heart valve clinics (HVC) approach vs. Standard of care (SOC) was evaluated on All-cause mortality (HR 0.63, 95% CI 0.40 to 0.98, p=0.038). Heart valve clinic follow-up was associated with reduced all-cause mortality compared with standard of care in moderate and asymptomatic severe aortic stenosis (HR 0.63; 95% CI 0.40-0.98; P=0.038).