Impact of selected comorbidities on the presentation and management of aortic stenosis
Language English Country Great Britain, England Media print
Document type Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
PubMed
32709699
PubMed Central
PMC7380845
DOI
10.1136/openhrt-2020-001271
PII: openhrt-2020-001271
Knihovny.cz E-resources
- Keywords
- aortic valve disease, cardiac surgery, prosthetic heart valves,
- MeSH
- Aortic Valve Stenosis epidemiology physiopathology surgery MeSH
- Time-to-Treatment trends MeSH
- Time Factors MeSH
- Heart Valve Prosthesis Implantation trends MeSH
- Pulmonary Disease, Chronic Obstructive epidemiology MeSH
- Renal Insufficiency, Chronic epidemiology MeSH
- Atrial Fibrillation epidemiology MeSH
- Ventricular Function, Left MeSH
- Risk Assessment MeSH
- Clinical Decision-Making MeSH
- Comorbidity MeSH
- Humans MeSH
- Prevalence MeSH
- Prospective Studies MeSH
- Registries MeSH
- Risk Factors MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Severity of Illness Index MeSH
- Stroke Volume MeSH
- Transcatheter Aortic Valve Replacement trends MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Europe epidemiology MeSH
BACKGROUND: Contemporary data regarding the impact of comorbidities on the clinical presentation and management of patients with severe aortic stenosis (AS) are scarce. METHODS: Prospective registry of severe patients with AS across 23 centres in nine European countries. RESULTS: Of the 2171 patients, chronic kidney disease (CKD 27.3%), left ventricular ejection fraction (LVEF) <50% (22.0%), atrial fibrillation (15.9%) and chronic obstructive pulmonary disease (11.4%) were the most prevalent comorbidities (49.3% none, 33.9% one and 16.8% ≥2 of these). The decision to perform aortic valve replacement (AVR) was taken in a comparable proportion (67%, 72% and 69%, in patients with 0, 1 and ≥2 comorbidities; p=0.186). However, the decision for TAVI was more common with more comorbidities (35.4%, 54.0% and 57.0% for no, 1 and ≥2; p<0.001), while the decision for surgical AVR (SAVR) was decreased with increasing comorbidity burden (31.9%, 17.4% and 12.3%; p<0.001). The proportion of patients with planned AVRs that were performed within 3 months was significantly higher in patients with 1 or ≥2 comorbidities than in those without (8.7%, 10.0% and 15.7%; p<0.001). Furthermore, the mean time to AVR was significantly shorter in patients with one (30.5 days) or ≥2 comorbidities (30.8 days) than in those without (35.7 days; p=0.012). Patients with reduced LVEF tended to be offered an AVR more frequently and with a shorter delay while patients with CKD were less frequently treated. CONCLUSIONS: Comorbidities in severe patients with AS affect the presentation and management of patients with severe AS. TAVI was offered more often than SAVR and performed within a shorter time period.
4th Medical Department Hietzing Hospital Vienna Austria
Cardiology Department AKH Celle Celle Germany
Centre Hospital d'Annecy Annecy France
Department of Cardiology and Angiology University of Kiel Kiel Germany
Department of Cardiology University of Erlangen Erlangen Germany
Department of Cardiothoracic Surgery Foundation IRCCS Policlinico S Matteo Pavia Italy
Division of Cardiology and URT CNR of IFC Magna Graecia University Catanzaro Italy
Edwards Lifesciences Nyon Switzerland
Edwards Lifesciences Prague Czech Republic
German Centre for Cardiovascular Research University Heart Center and Charité Berlin Germany
Herzkatheterlabor Nymphenburg and Department of Cardiology University of Munich Munich Germany
Institute for Pharmacology and Preventive Medicine Cloppenburg Germany
Interventional Cardiology Unit Hospital de la Santa Creu i Sant Pau Barcelona Spain
James Cook University Hospital Middlesbrough Middlesbrough UK
Sapienza University of Rome Rome Italy
St Bartholomew's Hospital London UK
University of Amsterdam Amsterdam Netherlands
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