Not adhering to recommended exams for severe narrowing of the aortic valve associated with increased heart failure

September 06, 2017

Patients with asymptomatic severe aortic stenosis who did not follow recommended guidelines for regular exams had poorer survival and were more likely to be hospitalized for heart failure, according to a study published by JAMA Cardiology.

Studies of patients with asymptomatic severe aortic stenosis have demonstrated a low risk of sudden cardiac death, but most of these patients will develop symptoms or have cardiac events within four years. Current practice guidelines recommend exams every six to 12 months for patients with asymptomatic severe aortic stenosis and normal left ventricular function, yet the benefit of this close monitoring is unknown.

Mario Goessl, M.D., Ph.D., of the Minneapolis Heart Institute Foundation, Minneapolis, and colleagues examined the association of guideline adherence with clinical outcomes in 300 patients with asymptomatic severe aortic stenosis. Rates of survival and adverse clinical events, including heart attack, stroke, and heart failure hospitalization, were compared between patients who adhered to guidance on exams and those who did not. Among the requirements of an exam were a cardiopulmonary physical examination and echocardiogram. Guideline adherence was defined as an exam every 12 (±6) months until aortic valve replacement or death during the follow-up period (median, 4.5 years).

Aortic valve replacement was performed more frequently (54 percent vs 19 percent) and the median time for this performance was earlier (2.2 years vs 3.5 years) in patients with guideline adherence. All-cause death was higher for nonadherent patients, and these patients also had a higher rate of hospital admission for heart failure decompensation in follow-up. Four-year survival that is free from death and heart failure hospitalization was higher for adherent patients than for nonadherent patients (39 percent vs 23 percent).

"To our knowledge, the present investigation is the first to demonstrate a survival benefit associated with adherence to guideline recommendations for serial clinical evaluations in patients with asymptomatic severe aortic stenosis. By helping to validate current guideline recommendations for closely monitoring patients with asymptomatic severe aortic stenosis, our findings support the efforts to improve guideline adherence, with the ultimate goal of improving clinical outcomes for these patients," the authors write.
-end-
For more details and to read the full study, please visit the For The Media website.

(doi:10.1001/jamacardio.2017.2952)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

To place an electronic embedded link to this study in your story: Link will be live at the embargo time: http://jamanetwork.com/journals/jamacardiology/fullarticle/10.1001/jamacardio.2017.2952

The JAMA Network Journals

Related Heart Failure Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Machining the heart: New predictor for helping to beat chronic heart failure
Researchers from Kanazawa University have used machine learning to predict which classes of chronic heart failure patients are most likely to experience heart failure death, and which are most likely to develop an arrhythmic death or sudden cardiac death.

Heart attacks, heart failure, stroke: COVID-19's dangerous cardiovascular complications
A new guide from emergency medicine doctors details the potentially deadly cardiovascular complications COVID-19 can cause.

Autoimmunity-associated heart dilation tied to heart-failure risk in type 1 diabetes
In people with type 1 diabetes without known cardiovascular disease, the presence of autoantibodies against heart muscle proteins was associated with cardiac magnetic resonance (CMR) imaging evidence of increased volume of the left ventricle (the heart's main pumping chamber), increased muscle mass, and reduced pumping function (ejection fraction), features that are associated with higher risk of failure in the general population

Transcendental Meditation prevents abnormal enlargement of the heart, reduces chronic heart failure
A randomized controlled study recently published in the Hypertension issue of Ethnicity & Disease found the Transcendental Meditation (TM) technique helps prevent abnormal enlargement of the heart compared to health education (HE) controls.

Beta blocker use identified as hospitalization risk factor in 'stiff heart' heart failure
A new study links the use of beta-blockers to heart failure hospitalizations among those with the common 'stiff heart' heart failure subtype.

Type 2 diabetes may affect heart structure and increase complications and death among heart failure patients of Asian ethnicity
The combination of heart failure and Type 2 diabetes can lead to structural changes in the heart, poorer quality of life and increased risk of death, according to a multi-country study in Asia.

Preventive drug therapy may increase right-sided heart failure risk in patients who receive heart devices
Patients treated preemptively with drugs to reduce the risk of right-sided heart failure after heart device implantation may experience the opposite effect and develop heart failure and post-operative bleeding more often than patients not receiving the drugs.

How the enzyme lipoxygenase drives heart failure after heart attacks
Heart failure after a heart attack is a global epidemic leading to heart failure pathology.

Novel heart pump shows superior outcomes in advanced heart failure
Severely ill patients with advanced heart failure who received a novel heart pump -- the HeartMate 3 left ventricular assist device (LVAD) -- suffered significantly fewer strokes, pump-related blood clots and bleeding episodes after two years, compared with similar patients who received an older, more established pump, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.

Read More: Heart Failure News and Heart Failure Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.