| Reasons for nonadherence to guidelines for aortic valve replacement in patients with severe aortic stenosis and potential solutions. | |
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MedLine Citation:
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PMID: 20403489 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The official guidelines for the treatment of patients with valvular heart disease have given a class I indication for aortic valve replacement in patients with symptomatic, severe aortic stenosis (AS). However, many patients with symptomatic, severe AS do not undergo AVR. We sought to determine the proportion and characteristics of patients with severe AS who do not undergo AVR in a university hospital and to identify the reasons for the lack of surgical referrals, despite the class I guideline indications. We retrospectively studied consecutive patients from an academic hospital with severe AS, as determined by echocardiographic criteria. The records were reviewed for clinical presentation, co-morbidities, surgical intervention, and outcomes. Of the 106 patients with severe AS, 33 (31%) had undergone AVR and 73 (69%) had not. Of those patients without AVR, 31 (42%) were symptomatic. The most common reason the patients with symptomatic, severe AS did not undergo AVR was their symptoms were thought to be unrelated to AS. Of the 42 patients (58%) who were deemed asymptomatic, only 4% had undergone exercise stress testing. With an average follow-up of 15 months, 15 (14%) of the 73 patients who did not undergo AVR died. In patients with severe AS, physicians commonly underrecognize symptoms and overestimate the operative risk. The exercise stress tests were underused in determining which patients with severe AS were symptomatic. As a result, many patients with a class I indication for AVR, who would benefit from this life-saving intervention, do not receive it. |
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Authors:
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Benjamin H Freed; Lissa Sugeng; Kathleen Furlong; Victor Mor-Avi; Jaishankar Raman; Valluvan Jeevanandam; Roberto M Lang |
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Publication Detail:
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Type: Comparative Study; Journal Article Date: 2010-03-11 |
Journal Detail:
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Title: The American journal of cardiology Volume: 105 ISSN: 1879-1913 ISO Abbreviation: Am. J. Cardiol. Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-04-20 Completed Date: 2010-06-15 Revised Date: 2010-08-30 |
Medline Journal Info:
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Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 1339-42 Citation Subset: AIM; IM |
Copyright Information:
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Copyright 2010 Elsevier Inc. All rights reserved. |
Affiliation:
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Section of Cardiology, University of Chicago Medical Center, Chicago, IL, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Aortic Valve Stenosis / diagnosis, mortality, surgery* Decision Making* Echocardiography Female Follow-Up Studies Guideline Adherence* Heart Valve Prosthesis Implantation / methods*, standards Humans Male Middle Aged Practice Guidelines as Topic* Retrospective Studies Severity of Illness Index Survival Rate Time Factors Treatment Outcome United States / epidemiology |
| Comments/Corrections | |
Comment In:
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Am J Cardiol. 2010 Sep 1;106(5):753
[PMID:
20723659
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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