title: Diagnostic and referral delay in patients with aortic stenosis is common and negatively affects outcome.
abstract: OBJECTIVE
  Aortic stenosis (AS) patients are often severely symptomatic at the time of aortic valve replacement (AVR). We wanted to investigate doctors' delay and its impact on outcome.
  
  
  METHODS
  AS patients undergoing AVR (n = 422) were included. Clinical and echocardiographic data at the time of diagnosis and preoperatively were noted. The risk of death after AVR was estimated using Poisson regression, incorporating age, gender, coronary artery disease, NYHA III/IV and time on the waiting list for AVR.
  
  
  RESULTS
  The age (mean+/-SD) was 71+/-8.6 years, 45% were women, and 48% were in NYHA III/IV. 55% underwent AVR within one year of diagnosis, indicating late diagnosis. The time from referral to AVR (median, range) was 112 (1-803) days. NYHA III/IV independently predicted mortality (hazard ratio 1.76, 95% CI 1.28-2.43, p = 0.0005). The time from referral to AVR influenced the risk of death immediately after operation (p = 0.0083).
  
  
  CONCLUSIONS
  Late diagnosis and late referral for AVR are common, and negatively influence outcome in patients with AS. Delay in surgery after referral increase the mortality immediately after AVR.
authors: Department of Clinical Physiology, Sahlgrenska University Hospital, Göteborg, Sweden. peter.gjertsson@vgregion.se
authors: Peter
authors: P
authors: Gjertsson
authors: Kenneth
authors: K
authors: Caidahl
authors: Anders
authors: A
authors: Odén
authors: Odd
authors: O
authors: Bech-Hanssen
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016017:Odds Ratio; D016012:Poisson Distribution; D011237:Predictive Value of Tests; D011379:Prognosis; D012017:Referral and Consultation; D012107:Research Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D014850:Waiting Lists