乌鸦传媒視頻

Patients getting guideline-recommended serial evaluations for their asymptomatic severe aortic stenosis are more likely to get an intervention and have better outcomes in the long run, according to a single-center study.

Those who stuck to the recommended tests were more likely to undergo aortic valve replacement (54% versus 19.4% for the non-adherent, P<0.001), and at an earlier time (median 2.2 versus 3.5 years, P<0.001).

This group also had a (38.7% versus 23.3%, adjusted HR 1.54, 95% CI 1.04-2.29), reported Mario Gössl, MD, PhD, of the Minneapolis Heart Institute Foundation, and colleagues online in JAMA Cardiology.

"Our findings support initiatives to improve adherence to practice guidelines that prescribe close monitoring of patients with asymptomatic severe aortic stenosis, with the ultimate goal of pursuing surgical intervention as early as possible when indications are present," they said. "The principal indication for surgery is the onset of symptoms or left ventricular dysfunction, but disease progression is usually insidious and therefore can be challenging to manage without close follow-up evaluations."

Asymptomatic severe aortic stenosis patients not getting these routine tests were associated with more all-cause mortality (HR 1.57, 95% CI 1.07-2.30) and hospital admission for heart failure decompensation (HR 1.66, 95% CI 1.27-2.18).

Gössl's group suggested that guideline adherence might help with clinical outcomes because disease progression requiring surgical intervention might be caught earlier under a closer watch.

From electronic health records, the investigators took a retrospective sample of 300 patients with normal left ventricular function (mean age 78.6; 47.7% men) for their study. Two-thirds had guideline-recommended serial evaluations every 6-12 months.

There were no between-group differences in baseline characteristics.

Chief among the study's limitations were its potential for selection bias and single-center nature.

Comment