Reasons for Nonadherence to Guidelines for Aortic Valve Replacement in Patients With Severe Aortic Stenosis and Potential Solutions

Benjamin H. Freed, Lissa Sugeng, Kathleen Furlong, Victor Mor-Avi*, Jaishankar Raman, Valluvan Jeevanandam, Roberto M. Lang

*Corresponding author for this work

Research output: Contribution to journalArticle

49 Scopus citations

Abstract

The official guidelines for the treatment of patients with valvular heart disease have given a class I indication for aortic valve replacement in patients with symptomatic, severe aortic stenosis (AS). However, many patients with symptomatic, severe AS do not undergo AVR. We sought to determine the proportion and characteristics of patients with severe AS who do not undergo AVR in a university hospital and to identify the reasons for the lack of surgical referrals, despite the class I guideline indications. We retrospectively studied consecutive patients from an academic hospital with severe AS, as determined by echocardiographic criteria. The records were reviewed for clinical presentation, co-morbidities, surgical intervention, and outcomes. Of the 106 patients with severe AS, 33 (31%) had undergone AVR and 73 (69%) had not. Of those patients without AVR, 31 (42%) were symptomatic. The most common reason the patients with symptomatic, severe AS did not undergo AVR was their symptoms were thought to be unrelated to AS. Of the 42 patients (58%) who were deemed asymptomatic, only 4% had undergone exercise stress testing. With an average follow-up of 15 months, 15 (14%) of the 73 patients who did not undergo AVR died. In patients with severe AS, physicians commonly underrecognize symptoms and overestimate the operative risk. The exercise stress tests were underused in determining which patients with severe AS were symptomatic. As a result, many patients with a class I indication for AVR, who would benefit from this life-saving intervention, do not receive it.

Original languageEnglish (US)
Pages (from-to)1339-1342
Number of pages4
JournalAmerican Journal of Cardiology
Volume105
Issue number9
DOIs
StatePublished - May 1 2010

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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