Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Oct 1;2(10):1141-1146.
doi: 10.1001/jamacardio.2017.2952.

Association of Guideline Adherence for Serial Evaluations With Survival and Adverse Clinical Events in Patients With Asymptomatic Severe Aortic Stenosis

Aisha Ahmed  1   2 , Paul Sorajja  1   2 , Ross F Garberich  1   2 , R Saeid Farivar  1   2 , Kevin M Harris  1   2 , Mario Gössl  1   2
Affiliations

Association of Guideline Adherence for Serial Evaluations With Survival and Adverse Clinical Events in Patients With Asymptomatic Severe Aortic Stenosis

Aisha Ahmed et al. JAMA Cardiol. .

Abstract

Importance: For patients with asymptomatic severe aortic stenosis and normal left ventricular function, current practice guidelines empirically recommend serial evaluations every 6 to 12 months. The benefit of this clinical monitoring is unknown.

Objective: To determine the association of guideline adherence with clinical outcomes in patients with asymptomatic severe aortic stenosis.

Design, setting, and participants: This retrospective cohort study involved 300 patients with asymptomatic severe aortic stenosis who were seen in the ambulatory Minneapolis Heart Institute at Abbott Northwestern Hospital. Rates of survival and adverse clinical events, including myocardial infarction, stroke, and heart failure hospitalization, were compared between patients who adhered to serial evaluation guidance and those who did not. Medical records were reviewed from July 25, 2007, to December 6, 2012. Data analysis took place from February 4, 2017, to July 10, 2017.

Main outcomes and measures: All-cause mortality, heart failure hospitalization, and major adverse clinical events during follow-up.

Results: The study population of 300 comprised 143 men (47.7%) and had a mean (SD) age of 78.6 (11.5) years. There were no differences in age, race/ethnicity, sex, comorbidities, insurance status, left ventricular function, and aortic stenosis severity between patients with (n = 202) and patients without (n = 98) guideline adherence. Aortic valve replacement (surgical or catheter based) was performed more frequently (54.0% vs 19.4%; P < .001) and the median (interquartile range) time for this performance was earlier (2.2 [1.2-3.6] years vs 3.5 [2.0-5.8] years; P < .001) in patients with guideline adherence. All-cause mortality was higher for nonadherent patients (hazard ratio [HR], 1.57; 95% CI, 1.07-2.30; P < .001), and these patients also had a higher rate of hospital admission for heart failure decompensation in follow-up (HR, 1.66; 95% CI, 1.27-2.18; P < .001). Four-year survival that is free from death and heart failure hospitalization was higher for adherent patients than for nonadherent patients (38.7% vs 23.3%; P < .001), and this difference remained significant in models adjusted for baseline variables (adjusted HR, 1.54; 95% CI, 1.04-2.29; P = .03).

Conclusions and relevance: The findings of this study support the need for close monitoring of patients with asymptomatic severe aortic stenosis and help to validate current guidelines for serial evaluations. These findings also support initiatives to improve guideline adherence in clinical practice.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Farivar reported receiving personal fees for consulting work from Abbott Vasculars, Edwards Lifesciences, and Medtronic. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Survival According to Guideline Adherence
A, Survival that is free of all-cause mortality. B, Survival that is free of heart failure hospitalization. C, Survival that is free of death or heart failure hospitalization.
Figure 2.
Figure 2.. Proportion of Patients With Aortic Valve Replacement During Follow-up According to Guideline Adherence
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Pellikka PA, Nishimura RA, Bailey KR, Tajik AJ. The natural history of adults with asymptomatic, hemodynamically significant aortic stenosis. J Am Coll Cardiol. 1990;15(5):1012-1017. - PubMed
    1. Rosenhek R, Binder T, Porenta G, et al. . Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med. 2000;343(9):611-617. - PubMed
    1. Rosenhek R, Zilberszac R, Schemper M, et al. . Natural history of very severe aortic stenosis. Circulation. 2010;121(1):151-156. - PubMed
    1. Nishimura RA, Otto CM, Bonow RO, et al. ; American College of Cardiology/American Heart Association Task Force on Practice Guidelines . 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(22):e57-e185. - PubMed
    1. Wang A, Grayburn P, Foster JA, et al. . Practice gaps in the care of mitral valve regurgitation: insights from the American College of Cardiology mitral regurgitation gap analysis and advisory panel. Am Heart J. 2016;172:70-79. - PubMed