| Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery? | |
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MedLine Citation:
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PMID: 16141261 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIMS: To analyse decision-making in elderly patients with severe, symptomatic aortic stenosis (AS). METHODS AND RESULTS: In the Euro Heart Survey on valvular heart disease, 216 patients aged > or =75 had severe AS (valve area < or =0.6 cm(2)/m(2) body surface area or mean gradient > or =50 mmHg) and angina or New York Heart Association class III or IV. Patient characteristics were analysed according to the decision to operate or not. A decision not to operate was taken in 72 patients (33%). In multivariable analysis, left ventricular (LV) ejection fraction [OR = 2.27, 95% CI (1.32-3.97) for ejection fraction 30-50, OR = 5.15, 95% CI (1.73-15.35) for ejection fraction < or =30 vs. >50%, P = 0.003] and age [OR = 1.84, 95% CI (1.18-2.89) for 80-85 years, OR=3.38, 95% CI (1.38-8.27) for > or =85 vs. 75-80 years, P = 0.008] were significantly associated with the decision not to operate; however, the Charlson comorbidity index was not [OR = 1.72, 95% CI (0.83-3.50), P = 0.14 for index > or =2 vs. <2]. Neurological dysfunction was the only comorbidity significantly linked with the decision not to operate. CONCLUSION: Surgery was denied in 33% of elderly patients with severe, symptomatic AS. Older age and LV dysfunction were the most striking characteristics of patients who were denied surgery, whereas comorbidity played a less important role. |
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Authors:
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Bernard Iung; Agnès Cachier; Gabriel Baron; David Messika-Zeitoun; François Delahaye; Pilar Tornos; Christa Gohlke-Bärwolf; Eric Boersma; Philippe Ravaud; Alec Vahanian |
Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't Date: 2005-09-01 |
Journal Detail:
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Title: European heart journal Volume: 26 ISSN: 0195-668X ISO Abbreviation: Eur. Heart J. Publication Date: 2005 Dec |
Date Detail:
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Created Date: 2005-11-29 Completed Date: 2006-07-11 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8006263 Medline TA: Eur Heart J Country: England |
Other Details:
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Languages: eng Pagination: 2714-20 Citation Subset: IM |
Affiliation:
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Cardiology Department, Bichat Hospital, AP-HP, Paris, France. bernard.iung@bch.aphp.fr |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Age Factors Aged Aged, 80 and over Aortic Valve Stenosis / surgery* Decision Making* Female Follow-Up Studies Humans Male Prognosis Refusal to Treat / statistics & numerical data* Risk Assessment Risk Factors Survival Analysis |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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