• Aortic Diseases

Although guidelines often recommend patients be managed at centres or in clinics that specialise in the patient’s specific medical condition, it has been challenging to convincingly demonstrate that specialised centres meaningfully impact patient outcomes. In this issue of Heart, Paolisso and colleagues1 report outcomes for 2129 patients seen for cardiovascular consultation with moderate aortic stenosis (mAS) or asymptomatic severe AS (asAS) in a single centre observational registry. The 251 patients seen in a heart valve clinic (HVC) were compared with the 1878 receiving standard-of-care (SOC). Although those in the HVC group had more clinic visits and more diagnostic tests than the SOC group, even with propensity score matching, those in the HVC group also received aortic valve replacement more promptly once an indication was present. Importantly, all-cause mortality (HR=0.63, 95% CI 0.40 to 0.98, p=0.038) and cardiovascular death (p=0.030) were lower in the HVC group compared with the SOC group. Management in a HVC remained an independent predictor of all-cause mortality (HR=0.54, 95% CI 0.34 to 0.85, p=0.007) on multivariable analysis (figure 1).

In the accompanying editorial, Iung2 emphasises the importance of frequent follow-up and patient education in patients with moderate to severe AS. As he comments on this study: “Relevant findings are the higher number of consultation (1.6±1.0 vs 0.8±0.9 per year) in the heart valve clinic and the average time duration of 40 min per …