title: Magnitude of negative impact of preoperative heart failure on mortality during aortic valve replacement in the medicare population.
abstract: BACKGROUND
  In patients with severe aortic stenosis, the development of heart failure (HF) prior to aortic valve replacement (AVR) is associated with worse prognosis. We sought to quantify the effect of progressive HF on mortality during AVR in the Medicare population over a 10-year period.
  
  
  METHODS
  Medicare beneficiaries 65 or greater years of age who underwent primary isolated AVR from 2000 through 2009 were included (n = 114,135). Logistic regression and Cox proportional hazards were used to model adjusted operative mortality (OM) and long-term survival, according to the presence of preoperative HF and its duration (≤ 3 vs > 3 months).
  
  
  RESULTS
  The incidence of preoperative comorbidities was high, and it was higher in patients with preoperative HF, compared with those without. Preoperative HF dramatically increased adjusted OM, odds ratio (OR) 1.57 (95% confidence interval [CI], 1.48 to 1.67). Preoperative HF greater than 3 months conferred a significant increase in adjusted OM compared with HF 3 months or less, OR 1.43 (95% CI, 1.32 to 1.55). Similarly, preoperative HF increased the likelihood of long-term mortality by 50%, hazard ratio (HR) 1.48 (95% CI, 1.45 to 1.51). Long-term mortality was higher for patients with longer duration of preoperative HF as compared with those without preoperative HF, HR 1.81 (95% CI, 1.75 to 1.87) and compared with patients with HF 3 months or less, HR 1.26 (95% CI, 1.23 to 1.30).
  
  
  CONCLUSIONS
  The magnitude of the negative impact of preoperative HF on operative mortality and long-term survival of elderly patients undergoing primary isolated AVR is significant with 50% increased likelihood of adverse outcome. Duration of preoperative HF is also significantly related to mortality. These data support AVR in the elderly prior to the development of HF.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois. Electronic address: cvassileva@siumed.edu.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Vassileva
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois.
authors.forename: Tesfaye
authors.initials: T
authors.lastname: Telila
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois.
authors.forename: Stephen
authors.initials: S
authors.lastname: Markwell
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois.
authors.forename: Stephen
authors.initials: S
authors.lastname: Hazelrigg
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000401:mortality* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare; D012307:Risk Factors; D015996:Survival Rate; D014481:United States