Highlights
- •Little is known about how Heart Team treatment decisions among patients with aortic valve stenosis are made under routine conditions.
- •The assessment of frailty is of paramount importance to guide patient-centred clinical decision-making in elderly patients with AVS.
- •Comorbidities, functional status and physical performance, were significantly associated with the consensual treatment decision-making.
Abstract
Background
Three treatment options are available for patients with aortic stenosis: surgical
aortic valve replacement (SAVR), transcatheter aortic valve implantation (TAVI) and
medical treatment (MT). However, little is known about how Heart Team treatment decisions
are made under routine conditions. The aim of this study was to identify the cardiac
and geriatric components associated with treatment decision-making in older patients
with symptomatic severe aortic stenosis.
Methods
Between 2011 and 2013, 337 consecutive patients ≥75 years old referred for pre-operative
evaluation in Nantes University Hospital had a comprehensive cardiac and geriatric
assessment. In this observational retrospective study, relationships between treatment
decision-making and cardiac or geriatric components were evaluated through multivariable
models.
Results
Surgical aortic valve replacement was proposed to 108 patients, TAVI to 131 and medical
treatment to 98 patients. Mean age was 83 ± 4 years and 51% were women. Geriatric components associated with treatment decision-making
between SAVR vs. TAVI were age (p < 0.001, OR = 0.790), comorbidity score (p = 0.027, OR = 0.86), functional status (p < 0.001, OR = 1.46), and gait speed (p < 0.001, OR = 0.23). Cardiac components associated with decision-making between SAVR vs. TAVI were
history of previous cardiac surgery (p < 0.001, OR = 0.09), left ventricular ejection fraction <50% (p < 0.001, OR = 0.14), coronary artery disease requiring revascularization (p = 0.019, OR = 0.4). Between TAVI vs. medical treatment, only history of previous cardiac surgery
and presence of another severe valve disease were significant.
Conclusion
Comorbidities, functional status and physical performance, were significantly associated
with the consensual treatment decision-making, independently of cardiac components
in older patients with symptomatic severe aortic stenosis.
Keywords
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Article info
Publication history
Published online: June 22, 2015
Accepted:
June 14,
2015
Received in revised form:
June 9,
2015
Received:
February 18,
2015
Identification
Copyright
© 2015 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
