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Determinants in treatment decision-making in older patients with symptomatic severe aortic stenosis

      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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