title: Role of a heart valve clinic programme in the management of patients with aortic stenosis.
abstract: OBJECTIVE
  We sought to assess the efficacy of a heart valve clinic (HVC) follow-up programme for patients with severe aortic stenosis (AS).
  
  
  RESULTS
  Three hundred and eighty-eight consecutive patients with AS (age 71 ± 10 years; aortic-jet velocity 5.1 ± 0.6 m/s) and an indication for aortic valve replacement (AVR) were included. Of these, 290 patients presented with an indication for surgery at their first visit at the HVC and 98 asymptomatic patients who had been enrolled in an HVC monitoring programme developed indications for surgery during follow-up. Time to symptom detection was significantly longer in patients that presented with symptoms at baseline (352 ± 471 days) than in patients followed in the HVC (76 ± 75 days, P < 0.001). Despite being educated to recognize and promptly report new symptoms, 77 of the 98 patients in the HVC programme waited until the next scheduled consultation to report them. Severe symptom onset (NYHA or CCS Class ≥III) was present in 61% of patients being symptomatic at the initial visit and in 34% of patients in the HVC programme (P < 0.001).
  
  
  CONCLUSIONS
  Delays in referral and symptom reporting as well as symptom denial are common in patients with AS. These findings support the concept of risk stratification to identify patients who may benefit from elective surgery. A structured HVC programme results in the detection of symptoms at an earlier and less severe stage and thus in an optimized timing of surgery.
authors: Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors: Robert
authors: R
authors: Zilberszac
authors: Department of Cardiology, Heart Valve Clinic, GIGA Cardiovascular Sciences, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium.
authors: Patrizio
authors: P
authors: Lancellotti
authors: Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel.
authors: Dan
authors: D
authors: Gilon
authors: Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors: Harald
authors: H
authors: Gabriel
authors: Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
authors: Michael
authors: M
authors: Schemper
authors: Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors: Gerald
authors: G
authors: Maurer
authors: Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy.
authors: Massimo
authors: M
authors: Massetti
authors: Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria rrosenhek@me.com.|Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy.
authors: Raphael
authors: R
authors: Rosenhek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D001317:Austria; D015331:Cohort Studies; D016001:Confidence Intervals; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011182:Postoperative Care; D011300:Preoperative Care; D016730:Program Development; D015397:Program Evaluation; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012380:Role; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014850:Waiting Lists
keywords: aortic stenosis; aortic valve replacement; heart valve clinic