European Heart Journal Advance Access originally published online on September 1, 2005
European Heart Journal 2005 26(24):2714-2720; doi:10.1093/eurheartj/ehi471
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Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery?
1Cardiology Department, Bichat Hospital, AP-HP, 46 rue Henri Huchard, 75018 Paris, France
2Epidemiology, Biostatistic, and Clinical Research Department, Bichat Hospital, AP-HP, Paris, France
3Cardiology Department, Hopital Cardiologique, Lyon, France
4Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain
5Cardiology Department, Heart Centre Bad Krozingen, Germany
6Thoraxcentre, Rotterdam, The Netherlands
Received 6 May 2005; revised 4 July 2005; accepted 4 August 2005; online publish-ahead-of-print 1 September 2005.
* Corresponding author. Tel: +33 1 40 25 67 60; fax: +33 1 40 25 67 32. E-mail address: bernard.iung{at}bch.aphp.fr
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 
75 had severe AS (valve area 
0.6 cm2/m2 body surface area or mean gradient 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 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 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 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.
Key Words: Aortic stenosis • Elderly • Aortic valve replacement
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