PT  - JOURNAL ARTICLE
AU  - Pasquale Paolisso
AU  - Monika Beles
AU  - Marta Belmonte
AU  - Emanuele Gallinoro
AU  - Cristina De Colle
AU  - Niya Mileva
AU  - Dario Tino Bertolone
AU  - Celine Deschepper
AU  - Jerrold Spapen
AU  - Sofie Brouwers
AU  - Ivan Degrieck
AU  - Filip Casselman
AU  - Bernard Stockman
AU  - Frank Van Praet
AU  - Martin Penicka
AU  - Carlos Collet
AU  - Eric Wyffels
AU  - Marc Vanderheyden
AU  - Emanuele Barbato
AU  - Jozef Bartunek
AU  - Guy Van Camp
TI  - Outcomes in patients with moderate and asymptomatic severe aortic stenosis followed up in heart valve clinics
AID  - 10.1136/heartjnl-2022-321874
DP  - 2023 Apr 01
TA  - Heart
PG  - 634--642
VI  - 109
IP  - 8
4099  - http://heart.bmj.com/content/109/8/634.short
4100  - http://heart.bmj.com/content/109/8/634.full
SO  - Heart2023 Apr 01; 109
AB  - Background Heart valve clinics (HVC) have been introduced to manage patients with valvular heart disease within a multidisciplinary team.Objective To determine the outcome benefit of HVC approach compared with standard of care (SOC) for patients with moderate and asymptomatic severe aortic stenosis (mAS and asAS).Methods Single-centre, observational registry of patients with mAS and asAS with at least one cardiac ambulatory consultation at our Cardiovascular Centre. Based on the outpatient strategy, patients were divided into HVC group, if receiving at least one visit at HVC, and SOC group, if followed by routine cardiac consultations.Results 2129 patients with mAS and asAS were divided into those followed in HVC (n=251) versus SOC group (n=1878). The mean age was 76.5±12.4 years; 919 (43.2%) had asAS. During a follow-up of 4.8±1.8 years, 822 patients (38.6%) died, 307 (14.4%) were hospitalised for heart failure and 596 (28%) underwent aortic valve replacement (AVR). After propensity score matching, the number of consultations per year, exercise stress tests, brain natriuretic peptide (BNP) determinations and CTs were higher in the HVC cohort (p<0.05 for all). A shorter time between indication of AVR and less advanced New York Heart Association class was reported in the HVC cohort (p<0.001 and p=0.032). Compared with SOC, the HVC approach was associated with reduced all-cause mortality (HR=0.63, 95% CI 0.40 to 0.98, p=0.038) and cardiovascular death (p=0.030). At multivariable analysis, the HVC remained an independent predictor of all-cause mortality (HR=0.54, 95% CI 0.34 to 0.85, p=0.007).Conclusions In patients with mAS and asAS, the HVC approach was associated with more efficient management and outcome benefit compared with SOC.Data are available on reasonable request.