Outcomes in patients with moderate and asymptomatic severe aortic stenosis followed up in heart valve clinics

• Published in: Heart (British Cardiac Society) Vol. 109; no. 8; pp. 634 - 642
• Main Authors: Paolisso, Pasquale, Beles, Monika, Belmonte, Marta, Gallinoro, Emanuele, De Colle, Cristina, Mileva, Niya, Bertolone, Dario Tino, Deschepper, Celine, Spapen, Jerrold, Brouwers, Sofie, Degrieck, Ivan, Casselman, Filip, Stockman, Bernard, Van Praet, Frank, Penicka, Martin, Collet, Carlos, Wyffels, Eric, Vanderheyden, Marc, Barbato, Emanuele, Bartunek, Jozef, Van Camp, Guy
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Cardiovascular Society 01.04.2023; BMJ Publishing Group LTD
• Subjects: Aged; Aged, 80 and over; Aortic stenosis; Aortic Valve - surgery; aortic valve stenosis; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - etiology; Aortic Valve Stenosis - surgery; Asymptomatic; Cardiology; Cardiovascular disease; Clinical outcomes; Ejection fraction; Heart failure; heart valve diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hospitalization; Humans; Medical prognosis; Middle Aged; outcome assessment, health care; Patients; Severity of Illness Index; transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome; Valvular heart disease; Belgium; aortic valve stenosis; transcatheter aortic valve replacement; heart valve diseases; outcome assessment, health care
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2022-321874

BackgroundHeart valve clinics (HVC) have been introduced to manage patients with valvular heart disease within a multidisciplinary team.ObjectiveTo 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).MethodsSingle-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.Results2129 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).ConclusionsIn patients with mAS and asAS, the HVC approach was associated with more efficient management and outcome benefit compared with SOC.