1
|
Shurrab M, Ko DT, Jackevicius CA, Tu K, Middleton A, Michael F, Austin PC. A review of the use of propensity score methods with multiple treatment groups in the general internal medicine literature. Pharmacoepidemiol Drug Saf 2023; 32:817-831. [PMID: 37144449 DOI: 10.1002/pds.5635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/31/2023] [Accepted: 04/30/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Propensity score (PS) methods with two treatment groups (e.g., treated vs. control) is a well-established technique for reducing the effects of confounding in nonrandomized studies. However, researchers are often interested in comparing multiple interventions. PS methods have been modified to incorporate multiple exposures. We described available techniques for PS methods in multicategory exposures (≥3 groups) and examined their use in the medical literature. METHODS A comprehensive search was conducted for studies published in PubMed, Embase, Google Scholar, and Web of Science until February 27, 2023. We included studies using PS methods for multiple groups in general internal medicine research. RESULTS The literature search yielded 4088 studies (2616 from PubMed, 86 from Embase, 85 from Google Scholar, 1671 from Web of Science, five from other sources). In total, 264 studies using PS method for multiple groups were identified; 61 studies were on general internal medicine topics and included. The most commonly used method was that of McCaffrey et al., which was used in 26 studies (43%), where the Toolkit for Weighting and Analysis of Nonequivalent Groups (TWANG) method and corresponding inverse probabilities of treatment weights were estimated via generalized boosted models. The next most commonly used method was pairwise propensity-matched comparisons, which was used in 20 studies (33%). The method by Imbens et al. using a generalized propensity score was implemented in six studies (10%). Four studies (7%) used a conditional probability of being in a particular group given a set of observed baseline covariates where a multiple propensity score was estimated using a non-parsimonious multinomial logistic regression model. Four studies (7%) used a technique that estimates generalized propensity scores and then creates 1:1:1 matched sets, and one study (2%) used the matching weight method. CONCLUSIONS Many propensity score methods for multiple groups have been adopted in the literature. The TWANG method is the most commonly used method in the general medical literature.
Collapse
Affiliation(s)
- Mohammed Shurrab
- Cardiology Department, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
- Health Sciences North Research Institute, Sudbury, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto and North, Ontario, Canada
| | - Dennis T Ko
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto and North, Ontario, Canada
- Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia A Jackevicius
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto and North, Ontario, Canada
- Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, California, USA
- Pharmacy Department, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Karen Tu
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto Western Hospital Family Health Team, University Health Network, Toronto, Ontario, Canada
| | - Allan Middleton
- Cardiology Department, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
| | - Faith Michael
- Cardiology Department, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
| | - Peter C Austin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto and North, Ontario, Canada
| |
Collapse
|
2
|
Solla-Suárez P, Avanzas P, Fernández-Fernández M, Pascual I, Moreno-Planillo C, Almendárez M, López-Álvarez E, Álvarez R, Coto-Montes A, Morís C, Gutiérrez-Rodríguez J. Functional continuum: independent predictor of one-year mortality and key decision-making element in older adults with severe aortic stenosis amenable to aortic valve replacement. Aging Clin Exp Res 2023; 35:323-331. [PMID: 36417136 DOI: 10.1007/s40520-022-02300-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/02/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The impact of functional capacity over the entire functional continuum in older adults undergoing aortic valve replacement (AVR) has not been studied to date. This study aims to analyze 1.- the distribution of a cohort of older adults presenting severe aortic stenosis (AS) amenable to AVR in the different categories of the Functional Continuum Scale (FCS); 2.- its association with decision-making regarding valve disease; and 3.- its impact upon the one-year mortality rate of surgical (SAVR), transcatheter (TAVR) aortic valve replacement, or the decision to provide conservative management (OMT). METHODS This prospective study included patients from the FRESAS (FRailty-Evaluation-in-Severe-Aortic-Stenosis) registry evaluated by the reference Heart-Team of a region in northern Spain. All the patients underwent comprehensive geriatric assessment. RESULTS The study comprised 257 patients aged 84.0 ± 3.9 years. MANAGEMENT SAVR: 25.3%, TAVR: 58.0% and OMT: 16.7%. Increased patient functional capacity was associated with an increased tendency to perform more invasive valve disease treatment. The overall one-year survival rate was 81.3%. One-year all-cause mortality: FCS-1 to FCS-2 "robust" 11.5%, FCS-3 to FCS-4 "prefrail" 14.7%, FCS-5 "frail" 19.2% and FCS-6 to FCS-8 "dependent" 45.0%; p < 0.001. Adjusted mortality analysis: FCS with HR = 1.206 [95%CI, 0.999-1.451 (p = 0.051)]; EuroSCORE-II with HR = 1.071 [95%CI, 1.006-1.161 (p = 0.033)]; and OMT with HR = 2.840 [95%CI, 1.409-5.772 (p = 0.004)] were retained in the final multivariable logistic regression model. CONCLUSIONS In older AS patients amenable to AVR, the FCS is a useful predictive tool that may aid clinical decision-making.
Collapse
Affiliation(s)
- Pablo Solla-Suárez
- Geriatrics Department, Geriatrics Clinical Management Area, Hospital Monte Naranco, HMN, Oviedo, Spain. .,Health Research Institute of Asturias, ISPA, Oviedo, Spain.
| | - Pablo Avanzas
- Cardiology Department, Cardiac Area, Hospital Universitario Central de Asturias, HUCA, Oviedo, Spain.,Health Research Institute of Asturias, ISPA, Oviedo, Spain.,University of Oviedo, UOV, Oviedo, Spain
| | - Marta Fernández-Fernández
- Geriatrics Department, Geriatrics Clinical Management Area, Hospital Monte Naranco, HMN, Oviedo, Spain
| | - Isaac Pascual
- Cardiology Department, Cardiac Area, Hospital Universitario Central de Asturias, HUCA, Oviedo, Spain.,Health Research Institute of Asturias, ISPA, Oviedo, Spain.,University of Oviedo, UOV, Oviedo, Spain
| | - Carmen Moreno-Planillo
- Geriatrics Department, Geriatrics Clinical Management Area, Hospital Monte Naranco, HMN, Oviedo, Spain
| | - Marcel Almendárez
- Cardiology Department, Cardiac Area, Hospital Universitario Central de Asturias, HUCA, Oviedo, Spain.,Health Research Institute of Asturias, ISPA, Oviedo, Spain
| | - Eva López-Álvarez
- Geriatrics Department, Geriatrics Clinical Management Area, Hospital Monte Naranco, HMN, Oviedo, Spain
| | - Rut Álvarez
- Cardiology Department, Cardiac Area, Hospital Universitario Central de Asturias, HUCA, Oviedo, Spain.,Health Research Institute of Asturias, ISPA, Oviedo, Spain
| | - Ana Coto-Montes
- Health Research Institute of Asturias, ISPA, Oviedo, Spain.,University of Oviedo, UOV, Oviedo, Spain.,Institute of Neurosciences of the Principality of Asturias, INEUROPA, Oviedo, Spain
| | - César Morís
- Cardiology Department, Cardiac Area, Hospital Universitario Central de Asturias, HUCA, Oviedo, Spain.,Health Research Institute of Asturias, ISPA, Oviedo, Spain.,University of Oviedo, UOV, Oviedo, Spain
| | - José Gutiérrez-Rodríguez
- Geriatrics Department, Geriatrics Clinical Management Area, Hospital Monte Naranco, HMN, Oviedo, Spain.,Health Research Institute of Asturias, ISPA, Oviedo, Spain
| |
Collapse
|
3
|
Brennan JM, Lowenstern A, Sheridan P, Boero IJ, Thourani VH, Vemulapalli S, Wang TY, Liska O, Gander S, Jager J, Leon MB, Peterson ED. Association Between Patient Survival and Clinician Variability in Treatment Rates for Aortic Valve Stenosis. J Am Heart Assoc 2021; 10:e020490. [PMID: 34387116 PMCID: PMC8475044 DOI: 10.1161/jaha.120.020490] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patients with symptomatic severe aortic stenosis (ssAS) have a high mortality risk and compromised quality of life. Surgical/transcatheter aortic valve replacement (AVR) is a Class I recommendation, but it is unclear if this recommendation is uniformly applied. We determined the impact of managing cardiologists on the likelihood of ssAS treatment. Methods and Results Using natural language processing of Optum electronic health records, we identified 26 438 patients with newly diagnosed ssAS (2011-2016). Multilevel, multivariable Fine-Gray competing risk models clustered by cardiologists were used to determine the impact of cardiologists on the likelihood of 1-year AVR treatment. Within 1 year of diagnosis, 35.6% of patients with ssAS received an AVR; however, rates varied widely among managing cardiologists (0%, lowest quartile; 100%, highest quartile [median, 29.6%; 25th-75th percentiles, 13.3%-47.0%]). The odds of receiving AVR varied >2-fold depending on the cardiologist (median odds ratio for AVR, 2.25; 95% CI, 2.14-2.36). Compared with patients with ssAS of cardiologists with the highest treatment rates, those treated by cardiologists with the lowest AVR rates experienced significantly higher 1-year mortality (lowest quartile, adjusted hazard ratio, 1.22, 95% CI, 1.13-1.33). Conclusions Overall AVR rates for ssAS were low, highlighting a potential challenge for ssAS management in the United States. Cardiologist AVR use varied substantially; patients treated by cardiologists with lower AVR rates had higher mortality rates than those treated by cardiologists with higher AVR rates.
Collapse
Affiliation(s)
- J Matthew Brennan
- Duke Clinical Research Institute Duke University School of Medicine Durham NC
| | - Angela Lowenstern
- Duke Clinical Research Institute Duke University School of Medicine Durham NC
| | - Paige Sheridan
- Department of Family Medicine and Public Health University of California, San Diego School of Medicine San Diego CA.,Boston Consulting Group Boston MA
| | | | - Vinod H Thourani
- Department of Cardiovascular Surgery Piedmont Heart Institute Atlanta GA
| | | | - Tracy Y Wang
- Duke Clinical Research Institute Duke University School of Medicine Durham NC
| | | | | | | | - Martin B Leon
- Columbia University Irving Medical Center and New York Presbyterian Hospital New York NY
| | - Eric D Peterson
- Duke Clinical Research Institute Duke University School of Medicine Durham NC
| |
Collapse
|
4
|
Rezende MO, Santos NSSD, Andrade AA, Francischini MS, Targino DVD, Souza CS, Maldi CDP, Siqueira DAAD, Bihan DCDSL, Pinto I, Ramos AIDO. Clinical Characteristics and Mid-Term follow-up of Elderly Patients with Severe Aortic Stenosis not Eligible for TAVI. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
5
|
Solla-Suárez P, Avanzas P, Pascual I, Bermúdez-Menéndez De La Granda M, Almendarez M, Arche-Coto JM, Hernández-Vaquero D, Lorca R, López-Álvarez E, Álvarez-Velasco R, Moreno-Planillo C, Morís de la Tassa C, Gutiérrez-Rodríguez J. Frailty Assessment in a Cohort of Elderly Patients with Severe Symptomatic Aortic Stenosis: Insights from the FRailty Evaluation in Severe Aortic Stenosis (FRESAS) Registry. J Clin Med 2021; 10:jcm10112345. [PMID: 34071871 PMCID: PMC8197816 DOI: 10.3390/jcm10112345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Precise evaluation of the degree of frailty is a fundamental part of the global geriatric assessment that helps to avoid therapies that could be futile. Our main objective was to determine the prevalence of frailty in a specific consult of patients undergoing aortic valve replacement. Methods: From May 2018 to February 2020, all consecutive patients ≥75 years old, with severe symptomatic aortic stenosis, undergoing valve replacement in the Principality of Asturias (Northern Spain) were evaluated. Results: A total of 286 patients were assessed. The mean age was 84 ± 4.01 years old; 175 (61.2%) were female. The short performance physical battery score was 8.5 ± 2.4 and the prevalence of frailty was 19.6% (56 patients). In the multivariable analysis, age, Barthel index and atrial fibrillation were independent predictors of frailty. Conclusions: The prevalence of frailty in our sample patients undergoing aortic valve replacement, evaluated by a standardized protocol, was 19.6%.
Collapse
Affiliation(s)
- Pablo Solla-Suárez
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, 33011 Oviedo, Spain; (P.S.-S.); (M.B.-M.D.L.G.); (J.M.A.-C.); (E.L.-Á.); (C.M.-P.)
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
| | - Pablo Avanzas
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
- Departamento de Medicina, Universidad de Oviedo, 33011 Oviedo, Spain
| | - Isaac Pascual
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
- Departamento de Biología Funcional, Universidad de Oviedo, 33011 Oviedo, Spain
- Correspondence:
| | - Manuel Bermúdez-Menéndez De La Granda
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, 33011 Oviedo, Spain; (P.S.-S.); (M.B.-M.D.L.G.); (J.M.A.-C.); (E.L.-Á.); (C.M.-P.)
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
| | - Marcel Almendarez
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Jose M. Arche-Coto
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, 33011 Oviedo, Spain; (P.S.-S.); (M.B.-M.D.L.G.); (J.M.A.-C.); (E.L.-Á.); (C.M.-P.)
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
| | - Daniel Hernández-Vaquero
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Rebeca Lorca
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Eva López-Álvarez
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, 33011 Oviedo, Spain; (P.S.-S.); (M.B.-M.D.L.G.); (J.M.A.-C.); (E.L.-Á.); (C.M.-P.)
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
| | - Rut Álvarez-Velasco
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Carmen Moreno-Planillo
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, 33011 Oviedo, Spain; (P.S.-S.); (M.B.-M.D.L.G.); (J.M.A.-C.); (E.L.-Á.); (C.M.-P.)
| | - César Morís de la Tassa
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
- Departamento de Medicina, Universidad de Oviedo, 33011 Oviedo, Spain
| | - José Gutiérrez-Rodríguez
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (P.A.); (M.A.); (D.H.-V.); (R.L.); (R.Á.-V.); (C.M.d.l.T.); (J.G.-R.)
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| |
Collapse
|
6
|
Ramos M, Quezada M, Ayala R, Gómez-Pavón FJ, Jaramillo J, Calderón-Domínguez M, Toro R. Estenosis aórtica grave asintomática en la población geriátrica: papel de la fragilidad y la comorbilidad en la mortalidad. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2019.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
7
|
Bonanad C, Guerrero C, Bianchi C. Milestones of the Section on Geriatric Cardiology of the Spanish Society of Cardiology: the r-evolution from 1995 to 2020. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 73:981-984. [PMID: 32798150 DOI: 10.1016/j.rec.2020.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain.
| | - Carme Guerrero
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Claudia Bianchi
- Servicio de Cardiología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| |
Collapse
|
8
|
Bonanad C, Guerrero C, Bianchi C. [Milestones of the Section on Geriatric Cardiology of the Spanish Society of Cardiology: the r-evolution from 1995 to 2020]. Rev Esp Cardiol 2020; 73:981-984. [PMID: 32836660 PMCID: PMC7319918 DOI: 10.1016/j.recesp.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - Carme Guerrero
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Claudia Bianchi
- Servicio de Cardiología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, España
| |
Collapse
|
9
|
Moss S, Doyle M, Nagaraja V, Peeceeyen S. A systematic review and meta-analysis of the clinical outcomes of TAVI versus SAVR in the octogenarian population. Indian J Thorac Cardiovasc Surg 2020; 36:356-364. [PMID: 33061143 DOI: 10.1007/s12055-019-00912-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 12/15/2022] Open
Abstract
Background Surgical aortic valve replacement (SAVR) has shown safe, robust results in elderly populations, and up until recently, was the gold standard for management of severe aortic stenosis. The approach to severe aortic stenosis in high-risk populations, such as octogenarians, has been challenged with the development of transcatheter-based strategies. We sought to systematically analyse outcomes between surgical and transcatheter aortic valve replacement (TAVI) in octogenarians. Method Electronic databases were searched from their inception until November 2018 for studies comparing SAVR to TAVI in octogenarians, according to a predefined search criterion. The primary end point was mortality, and secondary end points included post-procedural complications. Results The review yielded four observational studies. The total number of patients included was 1221 including 395 who underwent TAVI and 826 SAVR. On average, patients from both subgroups carried a high number of cardiac risk factors, and STS-PROM scoring yielded mean values equating to high-risk population groups, with significantly higher values for TAVI patients across the board. The presence of post-procedural moderate aortic regurgitation was noted only in the TAVI population (OR = 8.88; 95% CI (1.47-53.64), χ2 = 1.22; p = 0.02; I 2 = 0%). Otherwise, there were no significant differences when accounting for mortality (OR = 0.68; 95% CI (0.44-1.05), χ2 = 1.88; p = 0.60; I 2 = 0%), permanent pacemaker implantation groups (OR = 0.45; 95% CI (0.44-1.49), χ2 = 0.11; p = 0.19; I 2 = 0%), and neurological events (OR = 0.72; 95% CI (0.42-1.23), χ2 = 2.57; p = 0.23; I 2 = 22%). Discussion The analysed data on TAVI versus SAVR in the octogenarian population show that TAVI shows similar outcomes with relation to mortality and inpatient admission times, in a population with significantly higher risk profiles than their SAVR counterparts. TAVI has higher occurrences of post-procedural AR. TAVI still does not have robust long-term data to ensure its efficacy and rate of complications, but is showing promising results nonetheless.
Collapse
Affiliation(s)
- Stuart Moss
- St George Hospital, 1 Grey St, Kogarah, New South Wales 2217 Australia
| | - Mathew Doyle
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050 Australia
| | - Vinayak Nagaraja
- St George Hospital, 1 Grey St, Kogarah, New South Wales 2217 Australia
| | - Sheen Peeceeyen
- St George Hospital, 1 Grey St, Kogarah, New South Wales 2217 Australia
| |
Collapse
|
10
|
Popovic B, Molho A, Varlot J, Fay R, Metzdorf PA, Elfarra M, Maureira P, Juillière Y, Huttin O, Camenzind E. Prognostic influence of acute decompensated heart failure in patients planned for transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2020; 96:E542-E551. [DOI: 10.1002/ccd.28813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/30/2020] [Accepted: 02/14/2020] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Renaud Fay
- Department of Cardiology CHU Nancy France
| | | | - Mazen Elfarra
- Department of Cardiovascular Surgery CHU Nancy France
| | | | | | | | | |
Collapse
|
11
|
Roca F, Durand E, Eltchaninoff H, Chassagne P. Predictive Value for Outcome and Evolution of Geriatric Parameters after Transcatheter Aortic Valve Implantation. J Nutr Health Aging 2020; 24:598-605. [PMID: 32510112 DOI: 10.1007/s12603-020-1375-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify parameters of comprehensive geriatric assessment (CGA) CGA including ABCDEF score, a multidomain frailty assessment, associated with poor outcome after TAVI and to assess the evolution of CGA parameters at 6-months follow-up. DESIGN one-year monocentric prospective cohort study. SETTING Departments of geriatric medicine and cardiology in Rouen University Hospital, Normandy, France. PARTICIPANTS all patients over 70, selected for TAVI by a multidisciplinary "heart team". MEASUREMENTS 8-areas CGA was performed before TAVI and at 6-months follow-up. Poor outcome was defined as decrease in 1 BADL or unplanned readmission at 6 months or death within the first year after TAVI. Geriatric characteristics associated with poor outcome were assessed by logistic regression with surgical scores as bivariable. Geriatric characteristics were compared between baseline and 6-months follow-up. RESULTS 114 patients (mean age 85.8±5.3 years) were included. Mean EuroSCORE was 19.1±10.6%. Poor outcome occurred in 57(50.0%) patients. Loss of one BADL (OR:1.66, 95CI[1.11-2.48]), decrease in IADL (OR:1.41, 95CI[1.14-1.74]), in plasmatic albumin (OR:1.10, 95CI[1.01-1.20]), in MMSe (OR:1.13, 95CI[1.02-1.26]), low walking speed (OR:1.53, 95CI[1.01-2.33]) and ABCDEF score ≥2 (OR:1.63, 95CI[1.09-2.42]) were independently associated with poor outcome. In survivors with complete follow-up (n=80), most geriatric parameters were maintained 6 months after TAVI, but IADL decreased (5.6±1.9 to 4.9±2.2, p<0.001). MMSe increased in patients with previous cognitive impairments whereas it decreased in those without (p<0.001). CONCLUSION CGA parameters are independently associated with poor outcome after TAVI. These parameters, but IADL, are maintained at 6 months and course of the MMSe depends on previous cognitive status.
Collapse
Affiliation(s)
- F Roca
- Dr Roca Frédéric, Service de Médecine Gériatrique, CHU de Rouen, 76031 Rouen Cedex, France. Tel: +33 2 32 88 93 67, Fax: +33 2 32 88 06 01;
| | | | | | | |
Collapse
|
12
|
Kunstmann S, Gaínza F. CARDIOPATÍA EN EL PACIENTE ANCIANO. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2019.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
13
|
Ramos M, Quezada M, Ayala R, Gómez-Pavón FJ, Jaramillo J, Calderón-Domínguez M, Toro R. Asymptomatic aortic stenosis in a geriatric population. The role of frailty and comorbidity in mortality. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2019; 74:167-174. [PMID: 31882390 DOI: 10.1016/j.rec.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND OBJECTIVES The prognosis of asymptomatic severe aortic stenosis (AS) has not been widely documented in elderly patients who are frequently frail and have comorbidities. We sought to analyze the factors that influence early mortality in geriatric patients with asymptomatic severe AS. METHODS This ambispective cohort study included 104 patients aged 70 years or older with asymptomatic severe AS. Epidemiological, geriatric, clinical and echocardiographic variables were collected and compared between frail and nonfrail patients. During follow-up, the time from diagnosis to mortality and the causes of death were recorded. RESULTS Overall, 59.6% of the patients were frail. During follow-up, 69.4% of the frail patients died, with a median time to mortality of 2.52 years (95%CI, 1.36-3.69). The overall 1-year survival rate in frail patients was 76%. On multivariate analysis, age (HR, 2.47; 95%CI, 1.00-6.12), a Charlson comorbidity index ≥ 5 (HR, 3.75; 95%CI, 1.47-9.52) and frailty (HR, 6.67; 95%CI, 1.43-9.52) were independently related to mortality. In total, 8.7% of the patients had a Charlson comorbidity index ≥ 5, and all these patients died during follow-up, with a median survival of 1.01 years (95%CI, 0.36-1.67). The area under the receiver operating characteristic curve of the Charlson index was 0.739 (95%CI, 0.646-0.832). In this population, values ≥ 5 showed high specificity (100%) but low sensitivity. CONCLUSIONS A high prevalence of frailty was present in geriatric patients with asymptomatic severe AS. Age, a Charlson index ≥ 5 and frailty were independent factors for mortality, conferring an unfavorable short-term prognosis.
Collapse
Affiliation(s)
- Mónica Ramos
- Unidad de Cardiología, Hospital Central de la Cruz Roja, Madrid, Spain; Facultad de Medicina, Universidad Alfonso X el Sabio, Villanueva de la Cañada, Madrid, Spain.
| | - Maribel Quezada
- Unidad de Cardiología, Hospital Central de la Cruz Roja, Madrid, Spain; Facultad de Medicina, Universidad Alfonso X el Sabio, Villanueva de la Cañada, Madrid, Spain
| | - Rocío Ayala
- Unidad de Cardiología, Hospital Central de la Cruz Roja, Madrid, Spain; Facultad de Medicina, Universidad Alfonso X el Sabio, Villanueva de la Cañada, Madrid, Spain
| | - Francisco Javier Gómez-Pavón
- Facultad de Medicina, Universidad Alfonso X el Sabio, Villanueva de la Cañada, Madrid, Spain; Servicio de Geriatría, Hospital Central de la Cruz Roja, Madrid, Spain
| | - Javier Jaramillo
- Facultad de Medicina, Universidad Alfonso X el Sabio, Villanueva de la Cañada, Madrid, Spain; Servicio de Geriatría, Hospital Central de la Cruz Roja, Madrid, Spain
| | - María Calderón-Domínguez
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain; Departamento de Medicina, Facultad de Medicina, Cádiz, Spain
| | - Rocío Toro
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain; Departamento de Medicina, Facultad de Medicina, Cádiz, Spain
| |
Collapse
|
14
|
González Saldivar H, Vicent Alaminos L, Rodríguez-Pascual C, de la Morena G, Fernández-Golfín C, Amorós C, Baquero Alonso M, Martínez Dolz L, Ariza Solé A, Guzmán-Martínez G, Gómez-Doblas JJ, Arribas Jiménez A, Fuentes ME, Galian Gay L, Ruiz Ortiz M, Avanzas P, Abu-Assi E, Ripoll-Vera T, Díaz-Castro O, Pozo Osinalde E, Bernal E, Martínez-Sellés M. Evolución de los pacientes con estenosis aórtica grave tras la indicación de intervención. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
Nagao K, Taniguchi T, Morimoto T, Shiomi H, Ando K, Kanamori N, Murata K, Kitai T, Kawase Y, Izumi C, Miyake M, Mitsuoka H, Kato M, Hirano Y, Matsuda S, Inada T, Murakami T, Takeuchi Y, Yamane K, Toyofuku M, Ishii M, Minamino-Muta E, Kato T, Inoko M, Ikeda T, Komasa A, Ishii K, Hotta K, Higashitani N, Kato Y, Inuzuka Y, Maeda C, Jinnai T, Morikami Y, Saito N, Minatoya K, Kimura T. Anemia in Patients with Severe Aortic Stenosis. Sci Rep 2019; 9:1924. [PMID: 30760807 PMCID: PMC6374463 DOI: 10.1038/s41598-018-36066-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 11/09/2018] [Indexed: 01/31/2023] Open
Abstract
Prognostic impact of anemia complicating severe aortic stenosis (AS) remains unclear. We assessed the impact of anemia on cardiovascular and bleeding outcomes in 3403 patients enrolled in the CURRENT AS registry. 835 patients (25%) had mild (hemoglobin 11.0–12.9 g/dl for men/11.0–11.9 g/dl for women) and 1282 patients (38%) had moderate/severe anemia (Hb ≤ 10.9 g/dl) at diagnosis of severe AS. Mild and moderate/severe anemia were associated with significantly increased risks relative to no anemia (hemoglobin ≥13.0 g/dl for men/≥12.0 g/dl for women) for the primary outcome measure (aortic valve-related death or heart failure hospitalization) in the entire population [hazard ratio (HR): 1.30; 95% confidence interval (CI): 1.07–1.57 and HR: 1.56; 95%CI: 1.31–1.87, respectively] and in the conservative management stratum (HR: 1.73; 95%CI: 1.40–2.13 and HR: 2.05; 95%CI: 1.69–2.47, respectively). Even in the initial aortic valve replacement stratum, moderate/severe anemia was associated with significantly increased risk for the primary outcome measure (HR: 2.12; 95%CI: 1.44–3.11). Moreover, moderate/severe anemia was associated with significantly increased risk for major bleeding while under conservative management (HR: 1.93; 95%CI: 1.21–3.06). These results warrant further study to explore whether better management of anemia would lead to improvement of clinical outcomes.
Collapse
Affiliation(s)
- Kazuya Nagao
- Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Tomohiko Taniguchi
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroki Shiomi
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Norio Kanamori
- Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan
| | - Koichiro Murata
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yuichi Kawase
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Chisato Izumi
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Makoto Miyake
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Hirokazu Mitsuoka
- Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Yutaka Hirano
- Department of Cardiology, Kinki University Hospital, Osakasayama, Japan
| | - Shintaro Matsuda
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tsukasa Inada
- Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | | | - Yasuyo Takeuchi
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | | | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Mitsuru Ishii
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Eri Minamino-Muta
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Takao Kato
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Moriaki Inoko
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Tomoyuki Ikeda
- Department of Cardiology, Hikone Municipal Hospital, Hikone, Japan
| | - Akihiro Komasa
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Katsuhisa Ishii
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Kozo Hotta
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | | | - Yoshihiro Kato
- Department of Cardiology, Saiseikai Noe Hospital, Osaka, Japan
| | - Yasutaka Inuzuka
- Department of Cardiology, Shiga Medical Center for Adults, Moriyama, Japan
| | - Chiyo Maeda
- Department of Cardiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Toshikazu Jinnai
- Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Yuko Morikami
- Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Naritatsu Saito
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kimura
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | | |
Collapse
|
16
|
Tang L, Gössl M, Ahmed A, Garberich R, Bradley SM, Niikura H, Witt D, Pedersen WR, Bae R, Lesser JR, Harris KM, Sun B, Mudy K, Sorajja P. Contemporary Reasons and Clinical Outcomes for Patients With Severe, Symptomatic Aortic Stenosis Not Undergoing Aortic Valve Replacement. Circ Cardiovasc Interv 2018; 11:e007220. [DOI: 10.1161/circinterventions.118.007220] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Liang Tang
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China (L.T.)
| | - Mario Gössl
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Aisha Ahmed
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Ross Garberich
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Steven M. Bradley
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Hiroki Niikura
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Dawn Witt
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Wesley R. Pedersen
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Richard Bae
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - John R. Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Kevin M. Harris
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Benjamin Sun
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Karol Mudy
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| |
Collapse
|
17
|
Gómez-Doblas JJ, López-Garrido MA, Becerra-Muñoz VM, Orellana-Figueroa HN, Carro Hevia A, García de la Villa B, Cornide L, Martínez-Sellés M. Significant mitral regurgitation worsens the prognosis and favors the decision of conservative treatment in octogenarians with severe symptomatic aortic stenosis. Eur J Intern Med 2018; 55:40-46. [PMID: 29778589 DOI: 10.1016/j.ejim.2018.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/10/2018] [Accepted: 05/10/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The coexistence of significant mitral regurgitation (MR) and severe aortic stenosis is prevalent, has a prognostic impact and makes treatment in the elderly population a complex issue. The aim of this study is to determine the prevalence of significant MR among a population of octogenarians and its influence on treatment and prognosis. METHODS We used the data from PEGASO (Pronóstico de la Estenosis Grave Aórtica Sintomática del Octogenario), a prospective registry that consecutively included 928 patients aged ≥80 years with severe symptomatic aortic stenosis. RESULTS The prevalence of significant MR was 8.5% (79 patients) and independently associated with the decision to treat conservatively (odds ratio = 2.28, 95% confidence interval: 1.31-3.95, p = 0.003). The group of patients with significant MR had higher overall mortality at 12 months follow-up (51.9% vs 25%, p < 0.001), which remained on division into subgroups based on the presence of comorbidities (Charlson<5: 49.2% vs 21.9%, p < 0.001; and Charlson ≥5: 62.5% vs 41.7%, p = 0.07). Within the group of patients in whom conservative treatment was performed, those with significant MR had higher mortality at one year (62.7% vs 35%, p < 0.001). MR was a significant independent predictor of overall mortality at 12-month follow-up (hazard ratio = 1.87, 95% confidence interval: 1.09-3.18, p = 0.022). CONCLUSIONS Significant MR has a high prevalence and worsens the prognosis of octogenarian patients with severe symptomatic aortic stenosis, especially in patients with conservative treatment, independently of the existence of comorbidities.
Collapse
Affiliation(s)
- Juan José Gómez-Doblas
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain.
| | - Miguel Antonio López-Garrido
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Víctor Manuel Becerra-Muñoz
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Hugo Nelson Orellana-Figueroa
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Amelia Carro Hevia
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Luis Cornide
- Servicio de Medicina Interna, Hospital del Sureste, Arganda del Rey, Madrid, Spain
| | - Manuel Martínez-Sellés
- Hospital General Universitario Gregorio Marañón, Madrid, Spain; Universidad Complutense de Madrid y Universidad Europea de Madrid, Spain
| |
Collapse
|
18
|
González Saldivar H, Vicent Alaminos L, Rodríguez-Pascual C, de la Morena G, Fernández-Golfín C, Amorós C, Baquero Alonso M, Martínez Dolz L, Ariza Solé A, Guzmán-Martínez G, Gómez-Doblas JJ, Arribas Jiménez A, Fuentes ME, Galian Gay L, Ruiz Ortiz M, Avanzas P, Abu-Assi E, Ripoll-Vera T, Díaz-Castro O, Pozo Osinalde E, Bernal E, Martínez-Sellés M. Prognosis of Patients With Severe Aortic Stenosis After the Decision to Perform an Intervention. ACTA ACUST UNITED AC 2018; 72:392-397. [PMID: 29997054 DOI: 10.1016/j.rec.2018.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 03/02/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Current therapeutic options for severe aortic stenosis (AS) include transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). Our aim was to describe the prognosis of patients with severe AS after the decision to perform an intervention, to study the variables influencing their prognosis, and to describe the determinants of waiting time > 2 months. METHODS Subanalysis of the IDEAS (Influence of the Severe Aortic Stenosis Diagnosis) registry in patients indicated for TAVI or SAVR. RESULTS Of 726 patients with severe AS diagnosed in January 2014, the decision to perform an intervention was made in 300, who were included in the present study. The mean age was 74.0 ± 9.7 years. A total of 258 (86.0%) underwent an intervention: 59 TAVI and 199 SAVR. At the end of the year, 42 patients (14.0%) with an indication for an intervention did not receive it, either because they remained on the waiting list (34 patients) or died while waiting for the procedure (8 patients). Of the patients who died while on the waiting list, half did so in the first 100 days. The mean waiting time was 2.9 ± 1.6 for TAVI and 3.5 ± 0.2 months for SAVR (P = .03). The independent predictors of mortality were male sex (HR, 2.6; 95%CI, 1.1-6.0), moderate-severe mitral regurgitation (HR, 2.6; 95%CI, 1.5-4.5), reduced mobility (HR, 4.6; 95%CI, 1.7-12.6), and nonintervention (HR, 2.3; 95%CI, 1.02-5.03). CONCLUSIONS Patients with severe aortic stenosis awaiting therapeutic procedures have a high mortality risk. Some clinical indicators predict a worse prognosis and suggest the need for early intervention.
Collapse
Affiliation(s)
- Hugo González Saldivar
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Lourdes Vicent Alaminos
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | | | - Gonzalo de la Morena
- Unidad de Imagen, Servicio de Cardiología, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB), Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Carmen Amorós
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Luis Martínez Dolz
- Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Albert Ariza Solé
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Gabriela Guzmán-Martínez
- Servicio de Cardiología, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdIPaz), Madrid, Spain
| | | | | | | | - Laura Galian Gay
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Martín Ruiz Ortiz
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Emad Abu-Assi
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Tomás Ripoll-Vera
- Servicio de Cardiología, Hospital Son Llàtzer, Instituto de Investigación Sanitaria de Palma (Idispa), Palma de Mallorca, Balearic Islands, Spain
| | - Oscar Díaz-Castro
- Servicio de Cardiología, Hospital de Pontevedra, Vigo, Pontevedra, Spain
| | | | - Eva Bernal
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Universidad Europea, Universidad Complutense, Madrid, Spain.
| |
Collapse
|
19
|
Management of Nonagenarian Patients With Severe Aortic Stenosis: The Role of Comorbidity. Heart Lung Circ 2018; 27:219-226. [DOI: 10.1016/j.hlc.2017.02.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/25/2017] [Accepted: 02/28/2017] [Indexed: 11/23/2022]
|
20
|
Takagi H, Mitta S, Ando T. Long-term survival after transcatheter versus surgical aortic valve replacement for aortic stenosis: A meta-analysis of observational comparative studies with a propensity-score analysis. Catheter Cardiovasc Interv 2018; 92:419-430. [DOI: 10.1002/ccd.27521] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 12/24/2017] [Accepted: 01/08/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery; Shizuoka Medical Center; Shizuoka Japan
| | - Shohei Mitta
- Department of Cardiovascular Surgery; Shizuoka Medical Center; Shizuoka Japan
| | - Tomo Ando
- Department of Cardiology; Detroit Medical Center; Detroit Michigan
| | | |
Collapse
|
21
|
Importance of frailty and comorbidity in elderly patients with severe aortic stenosis. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2017; 14:379-382. [PMID: 29056944 PMCID: PMC5540869 DOI: 10.11909/j.issn.1671-5411.2017.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
22
|
Martínez-Sellés M, Ariza-Solé A, Vidán MT, Formiga F. [Cardiogeriatrics: What do the current guidelines say about the elderly patient?]. Rev Esp Geriatr Gerontol 2017; 52:115-118. [PMID: 28222942 DOI: 10.1016/j.regg.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 12/12/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España; Universidad Europea, Madrid, España
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital de Bellvitge, IDIBELL, L'Hospitalet de Llobregat (Barcelona), España
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España. CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES)
| | - Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, IDIBELL, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España.
| |
Collapse
|
23
|
Geriatric assessment to objectify the multidisciplinary heart team decision for treatment of elderly patients with severe, symptomatic aortic valve stenosis. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
24
|
Barbanti M, Gulino S, Costa G, Tamburino C. Pathophysiology, incidence and predictors of conduction disturbances during Transcatheter Aortic Valve Implantation. Expert Rev Med Devices 2017; 14:135-147. [PMID: 28092726 DOI: 10.1080/17434440.2017.1282819] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Over the past decade, transcatheter aortic valve implantation (TAVI) has evolved rapidly toward an extremely reproducible, safe and effective procedure, with a marked reduction of its related complications. However, the occurrence of conduction disturbances and the need for permanent pacemaker implantation (PPI) after TAVI remains a concern. Areas covered: In this article review, we will go through the mechanisms involved in conduction disturbances after TAVI, and we will discuss the key aspects of pathophysiology, incidence and predictors of conduction disturbances following Transcatheter Aortic Valve Implantation. The evaluation of patient's valve anatomy and the selection of the most appropriate prosthesis have been proposed as a valuable options to reduce the incidence of conductions disturbances. Moreover, in recent times, a great number of new TAVI devices, so-called 'second-generation devices', have been introduced to address the limitations of the first-generation devices, including conduction disturbance, with scarce results. Expert commentary: Conduction disturbances after TAVI are increasingly recognized as an important issue in TAVI complications. Further characterization of the procedural- and patient-related factors that contribute to the development of conduction abnormalities will help to improve prosthesis designs and patient selection, making TAVI even more safer.
Collapse
Affiliation(s)
- Marco Barbanti
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Simona Gulino
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Giuliano Costa
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Corrado Tamburino
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| |
Collapse
|
25
|
Rodríguez-Pascual C, Paredes-Galán E, Ferrero-Martínez AI, Baz-Alonso JA, Durán-Muñoz D, González-Babarro E, Sanmartín M, Parajes T, Torres-Torres I, Piñón-Esteban M, Calvo-Iglesias F, Olcoz-Chiva MT, Rodríguez-Artalejo F. The frailty syndrome and mortality among very old patients with symptomatic severe aortic stenosis under different treatments. Int J Cardiol 2016; 224:125-131. [DOI: 10.1016/j.ijcard.2016.09.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 08/20/2016] [Accepted: 09/12/2016] [Indexed: 12/28/2022]
|
26
|
Prognostic Usefulness of the 6-Minute Walk Test in Patients With Severe Aortic Stenosis. Am J Cardiol 2016; 118:1239-1243. [PMID: 27567134 DOI: 10.1016/j.amjcard.2016.07.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/10/2016] [Accepted: 07/10/2016] [Indexed: 11/21/2022]
Abstract
The 6-minute walk test distance (6MWD) has been shown to predict prognosis in selected cohorts of patients with heart failure and outcomes after surgical or transcatheter aortic valve implantation (AVI) in patients with symptomatic severe aortic stenosis (AS). Our objective was to evaluate the association between the 6MWD and outcome in patients with severe AS while remaining under medical treatment. In a prospective observational cohort study, a total of 149 patients diagnosed with severe AS by Doppler echocardiography underwent a 6-minute walk test. The single end point was a composite of all-cause death or hospitalization for heart failure. Patients receiving an AVI were censored from follow-up at the time of their AVI, so that only the events that occurred while the patients remained under medical treatment were included in the analysis. During follow-up (median 12.9 months), the end point occurred in 65 patients (43.6%). Univariate analysis showed an association between the 6MWD and the end point (p <0.001). After adjustment for symptoms, left ventricular ejection fraction, aortic valve area, Charlson co-morbidity score, and anemia, the 6MWD independently predicted the end point (adjusted hazard ratio 0.63; 95% confidence interval 0.45 to 0.89; p = 0.010). The incidence of the composite end point was 12 per 100 patient-years in patients with a 6MWD >331 m compared to 86 per 100 patient-years in those with a 6MWD ≤331 m (p <0.001). In conclusion, although patients with severe AS remain under medical treatment, the 6MWD is independently associated with all-cause death or hospitalization for heart failure.
Collapse
|
27
|
Takagi H, Umemoto T. Worse survival after transcatheter aortic valve implantation than surgical aortic valve replacement: A meta-analysis of observational studies with a propensity-score analysis. Int J Cardiol 2016; 220:320-7. [DOI: 10.1016/j.ijcard.2016.06.261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/15/2016] [Accepted: 06/27/2016] [Indexed: 12/24/2022]
|
28
|
Conservative management in very elderly patients with severe aortic stenosis: Time to change? J Cardiol 2016; 69:883-887. [PMID: 27644859 DOI: 10.1016/j.jjcc.2016.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/14/2016] [Accepted: 08/18/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite current recommendations, a high percentage of patients with severe symptomatic aortic stenosis are managed conservatively. The aim of this study was to study symptomatic patients undergoing conservative management from the IDEAS registry, describing their baseline clinical characteristics, mortality, and the causes according to the reason for conservative management. METHODS Consecutive patients with severe aortic stenosis diagnosed at 48 centers during January 2014 were included. Baseline clinical characteristics, echocardiographic data, Charlson index, and EuroSCORE-II were registered, including vital status and performance of valve intervention during one-year follow-up. For the purpose of this substudy we assessed symptomatic patients undergoing conservative management, including them in 5 groups according to the reason for performing conservative management [I: comorbidity/frailty (128, 43.8%); II: dementia 18 (6.2%); III: advanced age 34 (11.6%); IV: patients' refusal 62 (21.2%); and V: other reasons 50 (17.1%)]. RESULTS We included 292 patients aged 81.5±9 years. Patients from group I had higher Charlson index (4±2.3), higher EuroSCORE-II (7.5±6), and a higher overall (42.2%) and non-cardiac mortality (16.4%) than the other groups. In contrast, patients from group III had fewer comorbidities, lower EuroSCORE-II (4±2.5), and low overall (20.6%) and non-cardiac mortality (5.9%). CONCLUSIONS Patients with severe symptomatic aortic stenosis managed conservatively have different baseline characteristics and clinical course according to the reason for performing conservative management. A prospective assessment of comorbidity and other geriatric syndromes might contribute to improve therapeutic strategy in this clinical setting.
Collapse
|
29
|
Aortic valve stenosis: treatments options in elderly high-risk patients. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:473-4. [PMID: 27582760 PMCID: PMC4987414 DOI: 10.11909/j.issn.1671-5411.2016.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
|
30
|
Comparison of 1-Year Outcome in Patients With Severe Aorta Stenosis Treated Conservatively or by Aortic Valve Replacement or by Percutaneous Transcatheter Aortic Valve Implantation (Data from a Multicenter Spanish Registry). Am J Cardiol 2016; 118:244-50. [PMID: 27239021 DOI: 10.1016/j.amjcard.2016.04.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/26/2016] [Accepted: 04/26/2016] [Indexed: 11/24/2022]
Abstract
The factors that influence decision making in severe aortic stenosis (AS) are unknown. Our aim was to assess, in patients with severe AS, the determinants of management and prognosis in a multicenter registry that enrolled all consecutive adults with severe AS during a 1-month period. One-year follow-up was obtained in all patients and included vital status and aortic valve intervention (aortic valve replacement [AVR] and transcatheter aortic valve implantation [TAVI]). A total of 726 patients were included, mean age was 77.3 ± 10.6 years, and 377 were women (51.8%). The most common management was conservative therapy in 468 (64.5%) followed by AVR in 199 (27.4%) and TAVI in 59 (8.1%). The strongest association with aortic valve intervention was patient management in a tertiary hospital with cardiac surgery (odds ratio 2.7, 95% confidence interval 1.8 to 4.1, p <0.001). The 2 main reasons to choose conservative management were the absence of significant symptoms (136% to 29.1%) and the presence of co-morbidity (128% to 27.4%). During 1-year follow-up, 132 patients died (18.2%). The main causes of death were heart failure (60% to 45.5%) and noncardiac diseases (46% to 34.9%). One-year survival for patients treated conservatively, with TAVI, and with AVR was 76.3%, 94.9%, and 92.5%, respectively, p <0.001. One-year survival of patients treated conservatively in the absence of significant symptoms was 97.1%. In conclusion, most patients with severe AS are treated conservatively. The outcome in asymptomatic patients managed conservatively was acceptable. Management in tertiary hospitals is associated with valve intervention. One-year survival was similar with both interventional strategies.
Collapse
|
31
|
Selección de temas de actualidad en cardiología clínica, cardiología geriátrica e insuficiencia cardiaca y trasplante 2015. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
32
|
Martínez-Sellés M, Bouza E, Díez-Villanueva P, Valerio M, Fariñas MC, Muñoz-García AJ, Ruiz-Morales J, Gálvez-Acebal J, Antorrena I, de la Hera Galarza JM, Navas E, Muñoz P. Incidence and clinical impact of infective endocarditis after transcatheter aortic valve implantation. EUROINTERVENTION 2016; 11:1180-7. [DOI: 10.4244/eijy15m02_05] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
33
|
Clinical Cardiology, Geriatric Cardiology, Heart Failure, and Transplantation 2015: A Selection of Topical Issues. ACTA ACUST UNITED AC 2016; 69:159-66. [PMID: 26795924 DOI: 10.1016/j.rec.2015.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/21/2015] [Indexed: 01/24/2023]
|
34
|
Torres-Llergo J, Fernández-Olmo MR, Alania-Torres E, Lozano-Cabezas C, Padilla-Pérez M, Fernández-Guerrero JC. Diferencias en la presentación clínica y manejo terapéutico de la estenosis aórtica severa en mujeres en un centro de tercer nivel. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.carcor.2015.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
35
|
Hussain AI, Garratt AM, Beitnes JO, Gullestad L, Pettersen KI. Validity of standard gamble utilities in patients referred for aortic valve replacement. Qual Life Res 2015; 25:1703-12. [PMID: 26603737 DOI: 10.1007/s11136-015-1186-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Standard gamble (SG) is the preferred method of assessing preferences in situations with uncertainty and risk, which makes it relevant to patients considered for aortic valve replacement (AVR). The present study assesses SG preferences in patients with severe aortic stenosis (AS). METHODS All patients >18 years old with severe AS referred for AVR to our institution were invited to enroll in the study. The SG was administered by a clinical research nurse. The SF-36, EQ-5D 3L, Hospital Anxiety and Depression Scale (HADS), and AS symptoms were administered by self-completed questionnaire. We hypothesized that SG utilities would have low-to-moderate correlations with physical and mental aspects of health based on our pathophysiological understanding of severe AS. No correlations were expected with echocardiographic measures of the aortic valve. RESULTS The response rate for SG was 98 %. SG moderately correlated with physical aspects of SF-36 (PCS, role-physical, vitality), health transition, AS symptoms, and EQ-VAS (ρ S = 0.31-0.39, p < 0.001) and had low correlation with mental aspects of SF-36 and EQ-5D (ρ S = 0.17-0.28, p < 0.001). No correlation was found between SG and HADS, echocardiographic measures, age, gender, or education level (ρ S = 0.01-0.06). CONCLUSIONS SG is an acceptable and feasible method of assessing preferences in patients with severe AS that has evidence for validity. The inclusion of uncertainty lends the SG face validity in this population as a direct approach to assessing preferences and basis for QALY calculations.
Collapse
Affiliation(s)
- Amjad I Hussain
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Pb. 4950, Nydalen, 0424, Oslo, Norway.
| | - Andrew M Garratt
- The Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Jan Otto Beitnes
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Pb. 4950, Nydalen, 0424, Oslo, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Pb. 4950, Nydalen, 0424, Oslo, Norway
| | - Kjell I Pettersen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Pb. 4950, Nydalen, 0424, Oslo, Norway
| |
Collapse
|
36
|
Khounlaboud M, Donal E, Auffret V, Anselmi A, Ingels A, Flécher E, Verhoye JP, Daubert C, Le Breton H, Mabo P, Leguerrier A. Comparison of Preoperative and Postoperative Characteristics in Octogenarians Having Isolated Surgical Aortic Valve Replacement Before Versus After Introduction of Transcatheter Aortic Valve Implantation. Am J Cardiol 2015; 116:933-7. [PMID: 26187675 DOI: 10.1016/j.amjcard.2015.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 06/06/2015] [Accepted: 06/06/2015] [Indexed: 10/23/2022]
Abstract
Aortic stenosis (AS) is the most frequent heart valve disease. Surgical aortic valve replacement (SAVR) is the reference treatment. Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment. New strategies for treating the AS are upcoming. The aim of the study was to assess if the clinical profile of octogenarian patients treated surgically before and after the TAVI program initiation has changed. We retrospectively included consecutive octogenarian patients, who underwent isolated SAVR, from January 2006 to December 2011 in a single high-volume center. We compared preoperative and postoperative characteristics before and after the initiation of TAVI (February 2009). Five hundred seventeen patients were included: 229 in the "pre-TAVI" group (2006 to 2008), 288 in the "post-TAVI" group (2009 to 2011). The mean age was 83.2 ± 2.0 in the "pre-TAVI" group, 83.5 ± 2.1 in the "post-TAVI" group (p = 0.106). There were no significant differences in preoperative characteristics: New York Heart Association class (p = 0.374), history of heart failure (p = 0.680), left ventricular ejection fraction (59.8 ± 12.2% in the "pre-TAVI" group, 59.9 ± 11.3% in the "post-TAVI" group, p = 0.922), coronary artery disease (p = 0.431), chronic pulmonary disease (p = 0.363), and previous cardiac surgery (p = 0.085). The logistic EuroSCORE was 7.78 ± 4.60% in the "pre-TAVI" group and 7.33 ± 3.96% in the "post-TAVI" group (p = 0.236). The operative mortality (30-day) was comparable: 5.2% in the "pre-TAVI" group, 6.9% in the "post-TAVI" group (p = 0.424). Thus, with the emergence of TAVI, the number of octogenarian patients operated on, their preoperative characteristics, and the operative mortality remained comparable.
Collapse
|
37
|
Comorbidity and intervention in octogenarians with severe symptomatic aortic stenosis. Int J Cardiol 2015; 189:61-6. [DOI: 10.1016/j.ijcard.2015.04.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 02/01/2015] [Accepted: 04/02/2015] [Indexed: 11/18/2022]
|
38
|
Ungar A, Schoenenberger A, Maggi S, Martinez-Selles M, Michel JP. The value of comprehensive geriatric assessment in elderly patients with severe aortic stenosis – a position statement of the European Union Geriatric Medicine Society (EUGMS). Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2014.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
39
|
|
40
|
2014 update on interventional cardiology. ACTA ACUST UNITED AC 2015; 68:324-30. [PMID: 25749393 DOI: 10.1016/j.rec.2014.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 12/15/2014] [Indexed: 11/22/2022]
Abstract
This article reviews the most relevant publications and studies in the field of interventional cardiology in 2014. In the area of coronary interventional procedures, integrated treatment of acute coronary syndrome continues to be the subject of numerous studies that evaluate different devices and pharmacological and mechanical strategies that can be used without increasing the risk of hemorrhage or the need for reintervention. Certain anatomical substrates continue to generate a considerable number of publications, both on the outcomes with different stents and on the use of specific techniques. Bioabsorbable drug-eluting stents are used in increasingly complex lesions with promising results. The development of interventional procedures for structural heart disease continues to advance, with new evidence on percutaneously placed aortic valve prostheses, the outcome of percutaneous mitral valve repair, and the safety and efficacy of left atrial appendage occlusion. Finally, renal denervation has generated one of the major debates of the year.
Collapse
|
41
|
Affiliation(s)
- Luc A Pierard
- Department of Cardiology, Heart Valve Clinic, University of Liège, CHU Sart Tilman, Liège, Belgium
| | - Alec Vahanian
- Department of Cardiology, Bichat Hospital, Paris, France
| |
Collapse
|
42
|
Clinical significance of conduction disturbances after aortic valve intervention: current evidence. Clin Res Cardiol 2014; 104:1-12. [DOI: 10.1007/s00392-014-0739-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/24/2014] [Indexed: 12/16/2022]
|