Ungar Andrea, Rivasi Giulia, Testa Giuseppe Dario, Boureau Anne Sophie, Mattace-Raso Francesco, Martínez-Sellés Manuel, Bo Mario, Petrovic Mirko, Werner Nikos, Benetos Athanase
Geriatrics and Intensive Care Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
Nantes Université, CHU Nantes, Pole de Gérontologie Clinique, 44000, Nantes, France.
Eur Geriatr Med. 2024 Dec;15(6):1635-1643. doi: 10.1007/s41999-024-01015-9. Epub 2024 Jul 22.
Increasing evidence supports the implementation of geriatric assessment in the workup of older patients with aortic stenosis (AS). In 2012, an online European survey revealed that geriatricians were rarely involved in the assessment of candidates for transcatheter aortic valve implantation (TAVI). After a "call to action" for early involvement of geriatricians in AS evaluation, the survey was repeated in 2022. Our aim was to investigate whether geriatricians' role changed in the last decade.
Online survey conducted between December 16th, 2021, and December 15th, 2022. All members of the European Geriatric Medicine Society were invited to participate. The survey included 26 questions regarding geriatricians' experience with AS and TAVI.
Among 193 respondents (79.8% geriatricians), 73 (38%) reported to be involved in AS evaluation at least once a week. During 2 years prior to the survey, 43 (22.3%) had referred > 50% of their patients with severe AS for TAVI. Age influenced TAVI referral in a considerable proportion of respondents (36.8%). TAVI candidates were mainly referred to specialised cardiac centres with multidisciplinary teams (91.8%), including (47.2%) or not including (44.6%) a geriatrician. A total of 38.9% of respondents reported to be part of a multidisciplinary heart team. Geriatricians were less frequently involved (37%) than cardiologists (89.6%) and surgeons (53.4%) in pre-procedural TAVI management. Cardiologists were more frequently involved (85.5%) than geriatricians (33.7%) and surgeons (26.9%) in post-procedural management.
Geriatricians' involvement in AS management and multidisciplinary heart teams remains scarce. More efforts should be devoted to implement geriatricians' role in AS decision-making.
越来越多的证据支持在老年主动脉瓣狭窄（AS）患者的检查中实施老年医学评估。2012年，一项欧洲在线调查显示，老年医学专家很少参与经导管主动脉瓣植入术（TAVI）候选者的评估。在发出呼吁促使老年医学专家尽早参与AS评估之后，于2022年重复了该调查。我们的目的是调查在过去十年中，老年医学专家的角色是否发生了变化。
在2021年12月16日至2022年12月15日期间进行在线调查。邀请了欧洲老年医学学会的所有成员参与。该调查包括26个关于老年医学专家在AS和TAVI方面经验的问题。
在193名受访者（79.8%为老年医学专家）中，73名（38%）报告至少每周参与一次AS评估。在调查前的两年中，43名（22.3%）将其超过50%的重度AS患者转诊进行TAVI。年龄在相当一部分受访者（36.8%）中影响TAVI转诊。TAVI候选者主要被转诊至拥有多学科团队的专业心脏中心（91.8%），其中包括老年医学专家（47.2%）或不包括老年医学专家（44.6%）。共有38.9%的受访者报告是多学科心脏团队的成员。在TAVI术前管理中，老年医学专家的参与频率（37%）低于心脏病专家（89.6%）和外科医生（53.4%）。在术后管理中，心脏病专家的参与频率（85.5%）高于老年医学专家（33.7%）和外科医生（26.9%）。
老年医学专家在AS管理和多学科心脏团队中的参与仍然很少。应做出更多努力以落实老年医学专家在AS决策中的作用。
