RT Journal Article
SR Electronic
T1 Outcomes in patients with moderate and asymptomatic severe aortic stenosis followed up in heart valve clinics
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 634
OP 642
DO 10.1136/heartjnl-2022-321874
VO 109
IS 8
A1 Pasquale Paolisso
A1 Monika Beles
A1 Marta Belmonte
A1 Emanuele Gallinoro
A1 Cristina De Colle
A1 Niya Mileva
A1 Dario Tino Bertolone
A1 Celine Deschepper
A1 Jerrold Spapen
A1 Sofie Brouwers
A1 Ivan Degrieck
A1 Filip Casselman
A1 Bernard Stockman
A1 Frank Van Praet
A1 Martin Penicka
A1 Carlos Collet
A1 Eric Wyffels
A1 Marc Vanderheyden
A1 Emanuele Barbato
A1 Jozef Bartunek
A1 Guy Van Camp
YR 2023
UL http://heart.bmj.com/content/109/8/634.abstract
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.