120Delayed symptom-reporting in aortic stenosis: importance of risk stratification and impact of a valve clinic program on timing of surgery

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Background: We sought to assess the impact of a valve clinic based regular follow-up program on timing of surgery for patients with severe aortic stenosis (AS).Methods: The severity of symptom onset and the delay in symptom reporting was assessed in 388 consecutive patients (198 female, age 71±10 yrs) having an indication for aortic valve replacement due to AS based on current practice guidelines. Of these, 100 patients had been regularly followed in our valve clinic (including serial clinical and echocardiographic exams): these patients were instructed to promptly report the onset of symptoms and had developed indications for surgery during follow-up. 288 pts presented with an indication for surgery at first presentation in our valve clinic.Results: AS severity (peak aortic-jet velocity 5.1±0.6 m/s, aortic valve area 0.6±0.2 cm2) and prevalence of cardiovascular risk factors (hypertension, hypercholesterinemia, diabetes or coronary artery disease) were not significantly different between the two groups. The delay of symptom reporting was significantly longer in the group of patients being symptomatic at the first visit (351±471 days) than for patients being regularly followed (88±141 days, p<0.001). Despite being instructed to promptly report symptoms after their onset, only 21 of the 100 patients being regularly followed reported a symptom-onset before their next scheduled exam (delay of symptom onset reporting: 21±26 days), whereas 79 of these 100 patients reported symptoms at the scheduled follow-up visit only (delay of symptom onset reporting: 106±154 days, p<0.001). Severe symptom onset (NYHA or CCS class ≥ 2.5) was observed in 61% of patients being symptomatic at their first visit and in 33% ofpatients followed in the valve clinic (p<0.001). A very severe symptom onset (NYHA or CCS ≥ 3) was found in 25% of patients who presented with an indication for surgery and in 9% of patients enrolled in the follow-up program (p<0.001).Conclusion: Delayed symptom reporting is common in patients with aortic stenosis. In patients being regularly followed in a valve clinic program, symptoms are detected at an earlier and less severe stage resulting in optimized timing of aortic valve surgery. These findings also emphasise on the importance of risk stratification to identify patients benefiting from elective surgery.

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