Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
BMJ Open. 2017 Aug 21;7(8):e016489. doi: 10.1136/bmjopen-2017-016489.
To investigate symptoms and self-reported health of patients conservatively treated for aortic stenosis (AS) and to identify factors associated with treatment decision and patient outcomes.
A cross-sectional survey with an 18-month follow-up.
One tertiary university hospital in Western Norway.
In all, 1436 patients were diagnosed with AS between 2000 and 2012, and those 245 still under conservative treatment in 2013 were included in this study.
Primary outcome measures were symptoms and self-reported health status. Secondary outcomes were treatment decision and patient survival after 18 months.
A total of 136 patients with mean (SD) age 79 (12) years, 52% men responded. Among conservatively treated patients 77% were symptomatic. The symptom most frequently experienced was dyspnoea. Symptomatic patients reported worse physical and mental health compared with asymptomatic patients (effect size 1.24 and 0.74, respectively). In addition, symptomatic patients reported significantly higher levels of anxiety and depression compared with asymptomatic patients. However, symptom status did not correlate with haemodynamic severity of AS. After 18 months, 117 (86%) were still alive, 20% had undergone surgical aortic valve replacement (AVR) and 7% transcatheter aortic valve implantation (TAVI). When adjusting for age, gender, symptomatic status, severity of AS and European system for cardiac operative risk evaluation (EuroSCORE), patients with severe AS had more than sixfold chance of being scheduled for AVR or TAVI compared with those with moderate AS (HR 6.3, 95% CI 1.9 to 21.2, p=0.003). Patients with EuroSCORE ≥11 had less chance for undergoing AVR or TAVI compared with those with EuroSCORE ≤5 (HR 0.06, 95% CI 0.01 to 0.46, p=0.007).
Symptoms affected both physical and mental health in conservatively treated patients with AS. Many patients with symptomatic severe AS are not scheduled for surgery, despite the recommendations in current guidelines. The referral practice for AVR is a path for further investigation.
调查主动脉瓣狭窄（AS）保守治疗患者的症状和自我报告的健康状况，并确定与治疗决策和患者预后相关的因素。
一项横断面调查，随访时间为 18 个月。
挪威西部的一家三级大学医院。
共有 1436 名患者在 2000 年至 2012 年间被诊断为 AS，2013 年仍在保守治疗的 245 名患者被纳入本研究。
主要结果测量为症状和自我报告的健康状况。次要结局是 18 个月后的治疗决策和患者生存情况。
共有 136 名平均（标准差）年龄 79（12）岁的患者做出了回应，其中 52%为男性。在接受保守治疗的患者中，77%有症状。最常见的症状是呼吸困难。有症状的患者报告的身体和心理健康状况均比无症状患者差（效应大小分别为 1.24 和 0.74）。此外，有症状的患者报告的焦虑和抑郁水平明显高于无症状患者。然而，症状状况与 AS 的血液动力学严重程度无关。18 个月后，117 名（86%）患者仍然存活，20%接受了主动脉瓣置换术（AVR），7%接受了经导管主动脉瓣植入术（TAVI）。调整年龄、性别、症状状态、AS 严重程度和欧洲心脏手术风险评估系统（EuroSCORE）后，严重 AS 患者接受 AVR 或 TAVI 的可能性是中度 AS 患者的六倍以上（HR 6.3，95%CI 1.9 至 21.2，p=0.003）。EuroSCORE≥11 的患者接受 AVR 或 TAVI 的可能性低于 EuroSCORE≤5 的患者（HR 0.06，95%CI 0.01 至 0.46，p=0.007）。
在接受 AS 保守治疗的患者中，症状影响身体和心理健康。尽管当前指南有建议，但许多有症状的严重 AS 患者并未接受手术治疗。AVR 的转诊实践是进一步调查的一个途径。
