Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery?

• Published in: European heart journal 2005-12, Vol.26 (24), p.2714-2720
• Main Authors: Iung, Bernard, Cachier, Agnès, Baron, Gabriel, Messika-Zeitoun, David, Delahaye, François, Tornos, Pilar, Gohlke-Bärwolf, Christa, Boersma, Eric, Ravaud, Philippe, Vahanian, Alec
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Aortic stenosis; Aortic valve replacement; Aortic Valve Stenosis - surgery; Biological and medical sciences; Cardiology. Vascular system; Decision Making; Elderly; Endocardial and cardiac valvular diseases; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Prognosis; Refusal to Treat - statistics & numerical data; Risk Assessment; Risk Factors; Survival Analysis
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehi471

Aims To analyse decision-making in elderly patients with severe, symptomatic aortic stenosis (AS). Methods and results In the Euro Heart Survey on valvular heart disease, 216 patients aged ≥75 had severe AS (valve area ≤0.6 cm2/m2 body surface area or mean gradient ≥50 mmHg) and angina or New York Heart Association class III or IV. Patient characteristics were analysed according to the decision to operate or not. A decision not to operate was taken in 72 patients (33%). In multivariable analysis, left ventricular (LV) ejection fraction [OR=2.27, 95% CI (1.32–3.97) for ejection fraction 30–50, OR=5.15, 95% CI (1.73–15.35) for ejection fraction ≤30 vs. >50%, P=0.003] and age [OR=1.84, 95% CI (1.18–2.89) for 80–85 years, OR=3.38, 95% CI (1.38–8.27) for ≥85 vs. 75–80 years, P=0.008] were significantly associated with the decision not to operate; however, the Charlson comorbidity index was not [OR=1.72, 95% CI (0.83–3.50), P=0.14 for index ≥2 vs.