title: Prospective registry of symptomatic severe aortic stenosis in octogenarians: a need for intervention.
abstract: OBJECTIVE
  To study the factors associated with choice of therapy and prognosis in octogenarians with severe symptomatic aortic stenosis (AS).
  
  
  METHODS
  Prospective, observational, multicenter registry. Centralized follow-up included survival status and, if possible, mode of death and Katz index.
  
  
  METHODS
  Transnational registry in Spain.
  
  
  METHODS
  We included 928 patients aged ≥80 years with severe symptomatic AS.
  
  
  METHODS
  Aortic-valve replacement (AVR), transcatheter aortic-valve implantation (TAVI) or conservative therapy.
  
  
  METHODS
  All-cause death.
  
  
  RESULTS
  Mean age was 84.2 ± 3.5 years, and only 49.0% were independent (Katz index A). The most frequent planned management was conservative therapy in 423 (46%) patients, followed by TAVI in 261 (28%) and AVR in 244 (26%). The main reason against recommending AVR in 684 patients was high surgical risk [322 (47.1%)], other medical motives [193 (28.2%)], patient refusal [134 (19.6%)] and family refusal in the case of incompetent patients [35 (5.1%)]. The mean time from treatment decision to AVR was 4.8 ± 4.6 months and to TAVI 2.1 ± 3.2 months, P < 0.001. During follow-up (11.2-38.9 months), 357 patients (38.5%) died. Survival rates at 6, 12, 18 and 24 months were 81.8%, 72.6%, 64.1% and 57.3%, respectively. Planned intervention, adjusted for multiple propensity score, was associated with lower mortality when compared with planned conservative treatment: TAVI Hazard ratio (HR) 0.68 (95% confidence interval [CI] 0.49-0.93; P = 0.016) and AVR HR 0.56 (95% CI 0.39-0.8; P = 0.002).
  
  
  CONCLUSIONS
  Octogenarians with symptomatic severe AS are frequently managed conservatively. Planned conservative management is associated with a poor prognosis.
authors: Servicio de Cardiología, Hospital General Universitario Gregorio Marañón y Universidad Europea de Madrid, Madrid, Spain.
authors: M
authors: M
authors: Martínez-Sellés
authors: J J
authors: JJ
authors: Gómez Doblas
authors: A
authors: A
authors: Carro Hevia
authors: B
authors: B
authors: García de la Villa
authors: I
authors: I
authors: Ferreira-González
authors: A
authors: A
authors: Alonso Tello
authors: R
authors: R
authors: Andión Ogando
authors: T
authors: T
authors: Ripoll Vera
authors: A
authors: A
authors: Arribas Jiménez
authors: P
authors: P
authors: Carrillo
authors: C
authors: C
authors: Rodríguez Pascual
authors: M
authors: M
authors: Casares i Romeva
authors: X
authors: X
authors: Borras
authors: L
authors: L
authors: Cornide
authors: R
authors: R
authors: López-Palop
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D006328:Cardiac Catheterization / Q000379:methods*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D057186:Comparative Effectiveness Research; D005260:Female; D015577:Geriatric Assessment; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D020379:Risk Adjustment / Q000379:methods / Q000458:organization & administration; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents
keywords: ageing; aortic stenosis; aortic surgery