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Guideline nonadherence tied to HF in asymptomatic severe aortic stenosis
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Patients with asymptomatic severe aortic stenosis who did not adhere to guideline recommendations for serial clinical evaluations had an elevated risk for HF hospitalization and reduced survival rates, according to a study published in JAMA Cardiology.
Aisha Ahmed, BS, of the Minneapolis Heart Institute Foundation and Minneapolis Heart Institute at Abbott Northwestern Hospital, and colleagues reviewed electronic medical records from 300 patients (mean age, 79 years; 48% men) with asymptomatic severe aortic stenosis. Records included information on baseline patient characteristics, a comprehensive clinical evaluation and an ECG.
Guideline adherence was defined as those who were evaluated every 12 months until aortic valve replacement or death occurred during the follow-up period.
The outcomes of interest included HF hospitalization, all-cause mortality and major adverse clinical events during follow-up. Patients were followed up for a median of 4.5 years.
There were no differences in baseline characteristics, left ventricular function and aortic stenosis severity in patients who followed (n = 202) and did not follow guidelines (n = 98).
Patients who did not adhere to guidelines had a decreased rate of aortic valve replacement (19.4%) vs. those who adhered to guidelines (54%; P < .001). Aortic valve replacement was performed earlier in patients who adhered (2.2 years) compared with those who did not (3.5 years; P < .001).
All-cause mortality (HR = 1.57; 95% CI, 1.07-2.3) and HF hospitalization (HR = 1.66; 95% CI, 1.27-2.18) occurred more in patients without guideline adherence. The link between all-cause mortality and guideline nonadherence remained significant after multivariate adjustment (adjusted HR = 1.54; 95% CI, 1.04-2.29).
The rate of freedom from death and HF hospitalization at 4 years was 38.7% in adherent patients and 23.3% in nonadherent patients (P < .001).
“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,” Ahmed and colleagues wrote. – by Darlene Dobkowski
Disclosure s : Ahmed reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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