Many Aortic Stenosis Patients Are Not Treated
“Analysis of patients with severe valve diseases showed that symptomatic patients were frequently denied surgery”
–B. Iung, Bichat Hospital, Paris1
Surgery vs No Surgery in AS Patients
Guidelines are not consistently followed. In actual practice, more than one third of patients eligible for AVR are not referred for evaluation. As the chart illustrates, five different surveys identified 33% to 60% of patients not referred for surgery. Additionally, the Euro Heart Survey of 5000 patients from 92 centers in 25 European countries determined that 32.3% of patients over the age of 75 were denied surgery.1
Reasons Many Aortic Stenosis Patients Don't Get Needed Treatment
Reasons for AVR Non-Referral7
As the chart illustrates, aortic valve disease is common and its prevalence increases with age. For people over the age of 75 years, the prevalence of aortic stenosis is 3%. More than one in eight people over the age of 75 have moderate or severe valve disease.1 As the population ages, this condition becomes an important public health problem.1
Treatment decisions for older patients with severe AS are challenging due to comorbidity; they have a higher operative risk and have reduced life expectancy. In addition, their risk is increased by comorbidities such as heart disease and other conditions that are often present in this age group.8
- Iung B, Baron G, Tornos P, et al. Valvular heart disease in the community: a European experience. Curr Probl Cardiol 2007;32:609-61.
- Bouma BJ, van Den Brink RB, van Der Meulen JH, et al. To operate or not on elderly patients with aortic stenosis: the decision and its consequences. Heart 1999;82:143-8.
- Iung B, Cachier A, Baron G, et al. Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery? Eur Heart J 2005;26:2714-20.
- Pellikka PA, Sarano ME, Nishimura RA, et al. Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up. Circulation 2005;111:3290-5.
- Charlson E, Legedza AT, Hamel MB. Decision-making and outcomes in severe symptomatic aortic stenosis. J Heart Valve Dis 2006;15:312-21.
- Bach DS, Cimino N, Deeb GM. Unoperated patients with severe aortic stenosis. J Am Coll Cardiol 2007;50:2018-9.
- van Geldorp MW, van Gameren M, Kappetein AP, et al. Therapeutic decisions for patients with symptomatic severe aortic stenosis: room for improvement? Eur J Cardiothorac Surg 2009;35:953-7.
- Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012;33:2451-96.
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