title: Outcomes of patients with untreated severe aortic stenosis in real-world practice.
abstract: BACKGROUND
  Surgical aortic valve replacement remains the gold standard of the treatment of severe symptomatic aortic stenosis but is often not considered due to excessive risk factors and comorbidities especially in elderly patients. We describe the burden of untreated severe aortic stenosis at a tertiary care hospital in New Zealand.
  
  
  METHODS
  Consecutive patients with severe aortic stenosis presented between January-December, 2005 were studied retrospectively. Outcome assessment included mortality, hospital stay and on going symptoms (angina >CCS class II, dyspnoea >NYHA class II and syncope).
  
  
  RESULTS
  A total of 105 patients with severe aortic stenosis were identified (mean age 76 plus or minus 13 years, 51% men). Patients were divided into 3 groups according to the management strategy. (Group 1: Not referred for surgery as asymptomatic (n=25), Group 2: Declined for surgery (n=41), Group 3: Accepted for surgery (n=39)). Median follow-up was 34 months (interquartile range: 16-36 months). All-cause mortality in Group 1, Group 2 and Group 3 were 36%, 73% and 18% respectively while hospital days per 100 patient-years were 3.5, 10.1 and 6.4 and symptoms on last follow-up were 0%, 64% and 0% respectively. Almost half of symptomatic patients (Group 2 versus 3) were denied valve surgery due to comorbidities. Symptomatic patients had a significant mortality (p<0.0001) benefit with less hospitalisations (p<0.0001) post surgery.
  
  
  CONCLUSIONS
  Untreated symptomatic severe aortic stenosis is associated with a poor prognosis and significant morbidity. For symptomatic patients with severe aortic stenosis who are denied surgery, alternative therapies such as transcatheter aortic valve implantation could be a viable option.
authors.affiliation: Department of Cardiology, Waikato Hospital, Hamilton, New Zealand.
authors.forename: Suresh
authors.initials: S
authors.lastname: Perera
authors.forename: Namal
authors.initials: N
authors.lastname: Wijesinghe
authors.forename: Elene
authors.initials: E
authors.lastname: Ly
authors.forename: Gerard
authors.initials: G
authors.lastname: Devlin
authors.forename: Sanjeevan
authors.initials: S
authors.lastname: Pasupati
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D016009:Chi-Square Distribution; D015897:Comorbidity; D004452:Echocardiography; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis