Impact of selected comorbidities on the presentation and management of aortic stenosis

Rudolph TK, Messika-Zeitoun D, Frey N, Thambyrajah J, Serra A, Schulz E, Maly J, Aiello M, Lloyd G, Bortone AS, Clerici A, Delle-Karth G, Rieber J, Indolfi C, Mancone M, Belle L, Lauten A, Arnold M, Bouma BJ, Lutz M, Deutsch C, Kurucova J, Thoenes M, Bramlage P, Steeds RP (2020)

Publication Type: Journal article

Publication year: 2020

Journal

Book Volume: 7

Article Number: e001271

Journal Issue: 2

DOI: 10.1136/openhrt-2020-001271

Abstract

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.

Authors with CRIS profile

Involved external institutions

University of Amsterdam Netherlands (NL) Edwards Lifesciences Corporation United States (USA) (US) Christian-Albrechts-Universität zu Kiel Germany (DE) University of Birmingham United Kingdom (GB) Università degli studi "La Sapienza" Italy (IT) Institut für Pharmakologie und präventive Medizin (IPPMed GmbH) Germany (DE) University of Bari Aldo Moro / Università degli Studi di Bari Aldo Moro Italy (IT) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) University of Ottawa Canada (CA) University of Turin / Università degli Studi di Torino (UNITO) Italy (IT) James Cook University Hospital United Kingdom (GB) Policlinico San Matteo Pavia Fondazione IRCCS Italy (IT) Hospital de la Santa Creu i Sant Pau Spain (ES) Institute for Clinical and Experimental Medicine (IKEM) Czech Republic (CZ) Barts Health NHS Trust United Kingdom (GB) Ruhr-Universität Bochum (RUB) Germany (DE) Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel Austria (AT) Ludwig-Maximilians-Universität (LMU) Germany (DE) Magna Græcia University of Catanzaro / Università degli studi Magna Græcia di Catanzaro Italy (IT) Centre Hospitalier Annecy Genevois France (FR) Allgemeines Krankenhaus Celle Germany (DE)

How to cite

APA:

Rudolph, T.K., Messika-Zeitoun, D., Frey, N., Thambyrajah, J., Serra, A., Schulz, E.,... Steeds, R.P. (2020). Impact of selected comorbidities on the presentation and management of aortic stenosis. Open Heart, 7(2). https://doi.org/10.1136/openhrt-2020-001271

MLA:

Rudolph, Tanja K., et al. "Impact of selected comorbidities on the presentation and management of aortic stenosis." Open Heart 7.2 (2020).

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