Asymptomatic Severe Aortic Stenosis Guideline Nonadherence Associated With Higher Risk of Heart Failure

09/27/17

Patients with asymptomatic severe aortic stenosis who do not adhere to guidelines for serial clinical evaluations are at a higher risk for all-cause mortality and heart failure hospitalization.

Current guidelines for asymptomatic severe aortic stenosis and normal left ventricular function include serial evaluations every 6 to 12 months. However, the benefits of such frequent monitoring have yet to be studied.

Aisha Ahmed, BS, Minneapolis Heart Institute, Abbott Northwestern Hospital (MN), and colleagues conducted a review of medical records from patients with asymptomatic severe aortic stenosis to assess for a potential correlation between guideline adherence and improved outcomes. A total of 300 patients were sampled, with records detailing information on baseline characteristics, a comprehensive clinical evaluation, and an ECG.

Guideline adherence was measured as those who were evaluated every 12 months or until aortic valve replacement or death occurred during the follow-up period. Outcomes assessed in the study included heart failure hospitalization, all-cause mortality, and adverse events.

Results of the study were published in JAMA Cardiology (online September 6, 2017; doi:10.1001/jamacardio.2017.2952).

Researchers reported that baseline characteristics, left ventricular function, and aortic stenosis severity were comparable among patients who adhered (n = 202) and did not adhere to guidelines (n = 98).

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After a median follow-up of 4.5 years, patients who did not adhere to guidelines had a decreased rate of aortic valve replacement compared with those who adhered to guidelines (19.4% vs 54.0%, respectively). Similarly, all-cause mortality and heart failure hospitalization occurred more frequently in patients who did not adhered to guidelines. Rate of freedom from death and heart failure hospitalization after 4 years was 38.7% in adhering patients compared with 23% in non-adhering patients.

Researchers also noted that aortic valve replacement was performed earlier in patients who adhered (2.2 years) compared with those who did not adhere (3.5 years) to guidelines.

“Our findings support initiatives to improve adherence to practice guidelines that prescribe close monitoring of patients with asymptomatic severe aortic stenosis, with the ultimate goal of pursuing surgical intervention as early as possible when indications are present,” researchers concluded.—Zachary Bessette