Management of patients with severe aortic stenosis in the TAVI-era: How recent recommendations are translated into clinical practice

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00023001%3A_____%2F21%3A00080664" target="_blank" >RIV/00023001:_____/21:00080664 - isvavai.cz</a>

Alternative codes found

RIV/00216208:11130/21:10419997

Result on the web

<a href="https://openheart.bmj.com/content/openhrt/8/1/e001485.full.pdf" target="_blank" >https://openheart.bmj.com/content/openhrt/8/1/e001485.full.pdf</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1136/openhrt-2020-001485" target="_blank" >10.1136/openhrt-2020-001485</a>

Result language

angličtina

Original language name

Management of patients with severe aortic stenosis in the TAVI-era: How recent recommendations are translated into clinical practice

Original language description

Objective Approximately 3.4% of adults aged &gt;75 years suffer from aortic stenosis (AS). Guideline indications for aortic valve replacement (AVR) distinguish between patients with symptomatic and asymptomatic severe AS. The present analysis aims to assess contemporary practice in the treatment of severe AS across Europe and identify characteristics associated with treatment decisions, namely denial of AVR in symptomatic patients and assignment of asymptomatic patients to AVR. Methods Participants of the prospective, multinational IMPULSE database of patients with severe AS were grouped according to AS symptoms, and stratified into subgroups based on assignment to/denial of AVR. Results Of 1608 symptomatic patients, 23.8% did not undergo AVR and underwent medical treatment. Denial was independently associated with multiple factors, including severe frailty (p=0.024); mitral (p=0.002) or tricuspid (p=0.004) regurgitation grade III/IV, and the presence of renal impairment (p=0.017). Of 392 asymptomatic patients, 86.5% had no prespecified indication for AVR. Regardless, 36.3% were assigned to valve replacement. Those with an indexed aortic valve area (AVA; p=0.045) or left ventricular ejection fraction (LVEF; p&lt;0.001) below the study median; or with a left ventricular end systolic diameter above the study median (p=0.007) were more likely to be assigned to AVR. Conclusions There may be considerable discrepancies between guideline-based recommendations and clinical practice decision-making in the treatment of AS. It appears that guidelines may not fully capture the complete clinical spectrum of patients with AS. Thus, there is a need to find ways to increase their acceptance and the rate of adoption. © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Czech name

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Czech description

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Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

—

OECD FORD branch

30201 - Cardiac and Cardiovascular systems

Project

—

Continuities

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Publication year

2021

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

Open Heart

ISSN

2053-3624

e-ISSN

—

Volume of the periodical

8

Issue of the periodical within the volume

1

Country of publishing house

GB - UNITED KINGDOM

Number of pages

11

Pages from-to

"art. no. e001485"

UT code for WoS article

000609873000001

EID of the result in the Scopus database

2-s2.0-85099375643