title: Conservative management in very elderly patients with severe aortic stenosis: Time to change?
abstract: BACKGROUND
  Despite current recommendations, a high percentage of patients with severe symptomatic aortic stenosis are managed conservatively. The aim of this study was to study symptomatic patients undergoing conservative management from the IDEAS registry, describing their baseline clinical characteristics, mortality, and the causes according to the reason for conservative management.
  
  
  METHODS
  Consecutive patients with severe aortic stenosis diagnosed at 48 centers during January 2014 were included. Baseline clinical characteristics, echocardiographic data, Charlson index, and EuroSCORE-II were registered, including vital status and performance of valve intervention during one-year follow-up. For the purpose of this substudy we assessed symptomatic patients undergoing conservative management, including them in 5 groups according to the reason for performing conservative management [I: comorbidity/frailty (128, 43.8%); II: dementia 18 (6.2%); III: advanced age 34 (11.6%); IV: patients' refusal 62 (21.2%); and V: other reasons 50 (17.1%)].
  
  
  RESULTS
  We included 292 patients aged 81.5±9 years. Patients from group I had higher Charlson index (4±2.3), higher EuroSCORE-II (7.5±6), and a higher overall (42.2%) and non-cardiac mortality (16.4%) than the other groups. In contrast, patients from group III had fewer comorbidities, lower EuroSCORE-II (4±2.5), and low overall (20.6%) and non-cardiac mortality (5.9%).
  
  
  CONCLUSIONS
  Patients with severe symptomatic aortic stenosis managed conservatively have different baseline characteristics and clinical course according to the reason for performing conservative management. A prospective assessment of comorbidity and other geriatric syndromes might contribute to improve therapeutic strategy in this clinical setting.
authors.affiliation: Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Bernal
authors.affiliation: Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. Electronic address: aariza@bellvitgehospital.cat.
authors.forename: Albert
authors.initials: A
authors.lastname: Ariza-Solé
authors.affiliation: Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Formiga
authors.affiliation: Hospital Álvaro Cunqueiro de Vigo, Pontevedra, Spain.
authors.forename: Emad
authors.initials: E
authors.lastname: Abu-Assi
authors.affiliation: Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Carol
authors.affiliation: Hospital de la Vall d'Hebron, Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Galián
authors.affiliation: Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayés-Genís
authors.affiliation: Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Hugo González
authors.initials: HG
authors.lastname: Saldivar
authors.affiliation: Hospital Universitario La Princesa, Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Díez-Villanueva
authors.affiliation: Hospital General Universitario Gregorio Marañón, Madrid, Spain; Universidad Europea y Universidad Complutense, Madrid, Spain.
authors.forename: Manuel Martínez
authors.initials: MM
authors.lastname: Sellés
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000601:surgery*; D015897:Comorbidity; D000072700:Conservative Treatment; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D012042:Registries; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Comorbidity; Conservative management; Elderly; Mortality; Severe aortic stenosis