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Aortic stenosis prognosis in older patients: frailty is a strong marker of early congestive heart failure admissions

Influence of frailty in aortic stenosis
  • M. RamosEmail author
  • D. M. Quezada
  • R. Ayala
  • F. J. Gómez-Pavón
  • J. Jaramillo
  • R. Toro
Research Paper
  • 7 Downloads

Key Summary Points

Aim

Analyse which factors could influence in earlier hospitalizations for congestive heart failure in geriatric patients with degenerative aortic stenosis.

Findings

The first admission for congestive heart failure was independently related to frailty (HR 4.46, 95% CI: 1.38–14.41). The median time to admission for frail patients was 1.08 years (95% CI 0.30–1.86).

Message

In our study, there was an increased risk of congestive heart failure admission in frail patients with moderate-severe degenerative aortic stenosis.

Abstract

Purpose

Degenerative aortic stenosis has become a new valvular epidemic in the last few decades due to its high prevalence in the geriatric population. We sought to analyse factors that could influence earlier hospitalization for congestive heart failure in geriatric patients with moderate–severe degenerative aortic stenosis.

Methods

This investigation was an ambispective cohort study of 104 patients aged 70 years or older with moderate–severe aortic stenosis. Epidemiological, geriatric, clinical, echocardiographic and electrocardiographic variables were collected. During the follow-up, the number of admissions for congestive heart failure and the time elapsed from diagnosis to first admission were recorded.

Results

A total of 45.2% of the patients were admitted for congestive heart failure, with a median time to first admission of 3 years (95% CI 1.88–4.25). For patients aged 85 years or older, this median was 8.07 months (95% CI 0.05–1.99). The first admission for congestive heart failure was independently related to frailty (HR 4.46, 95% CI: 1.38–14.41), atrial fibrillation (HR 2.19, 95% CI: 1.01–4.73), a high EuroSCORE (HR 1.03, 95% CI: 1.00–1.05), the affected valvular area (HR 0.11, 95% CI: 0.02–0.47), age (HR 1.11, 95% CI: 1.04–1.18) and renal failure (HR 4.13, 95% CI: 1.46–11.63). The median time to admission for frail patients was 1.08 years (95% CI 0.30–1.86).

Conclusions

In geriatric patients with moderate–severe degenerative aortic stenosis, frailty is an independent marker of early congestive heart failure admission with a powerful and important association.

Keywords

Aortic stenosis Congestive heart failure Echocardiography Older patients Frailty 

Notes

Acknowledgements

This work was partially supported by Grants (to MR and MQ) from the VII Convocatoria del Banco de Santander and Alfonso X el Sabio University. Additionally, this work was supported by (RT) and the Fundación Pública Andaluza Progreso y Salud para la Financiación de la I+i Biomédica y en Ciencias de las Salud en Andalucía (PI-0011/2014) and (PI2017-0048 ITI Cádiz).

Author contributions

Study concept and design: Dr. Mónica Ramos. Recruitment of participants and/or data collection: Dr. Rocío Ayala, Dr. Javier Jaramillo. Analysis and interpretation of data: Dr. F. Javier Gómez Pavón, Dr. D. Maribel Quezada. Preparation of manuscript: Dr. Rocío Toro, Dr. Mónica Ramos.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The protocol for the research project was approved by the Alfonso X el Sabio Ethics Committee and conforms to the provisions of the Declaration of Helsinki.

Informed consent

Informed written consent was given by the study participants.

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Copyright information

© European Geriatric Medicine Society 2019

Authors and Affiliations

  1. 1.Cardiology Department, Hospital Central de la Cruz Roja, School of MedicineAlfonso X el Sabio UniversityMadridSpain
  2. 2.Geriatrics Department, Hospital Central de la Cruz Roja, School of MedicineAlfonso X el Sabio UniversityMadridSpain
  3. 3.Cardiology Department, School of MedicineCádiz University and Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA)CádizSpain

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