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Title: Reasons for Choosing Conservative Management in Symptomatic Patients With Severe Aortic Stenosis --Observations From the CURRENT AS Registry--
Authors: Ishii, Mitsuru
Taniguchi, Tomohiko
Morimoto, Takeshi
Ogawa, Hisashi
Masunaga, Nobutoyo
Abe, Mitsuru
Yoshikawa, Yusuke
Shiomi, Hiroki
Ando, Kenji
Kanamori, Norio
Murata, Koichiro
Kitai, Takeshi
Kawase, Yuichi
Izumi, Chisato
Miyake, Makoto
Mitsuoka, Hirokazu
Kato, Masashi
Hirano, Yutaka
Matsuda, Shintaro
Nagao, Kazuya
Inada, Tsukasa
Mabuchi, Hiroshi
Takeuchi, Yasuyo
Yamane, Keiichiro
Toyofuku, Mamoru
Minamino-Muta, Eri
Kato, Takao
Inoko, Moriaki
Ikeda, Tomoyuki
Komasa, Akihiro
Ishii, Katsuhisa
Hotta, Kozo
Higashitani, Nobuya
Kato, Yoshihiro
Inuzuka, Yasutaka
Jinnai, Toshikazu
Morikami, Yuko
Akao, Masaharu
Minatoya, Kenji
Kimura, Takeshi
Author's alias: 谷口, 智彦
南野-牟田, 恵里
加藤, 貴雄
湊谷, 謙司
木村, 剛
Keywords: Aortic stenosis
Treatment strategy
Issue Date: Sep-2019
Publisher: Japanese Circulation Society
Journal title: Circulation Journal
Volume: 83
Issue: 9
Start page: 1944
End page: 1953
Abstract: Background:There has not been a previous report on the long-term outcomes of those patients who refuse aortic valve replacement (AVR) despite physicians’ recommendations. Methods and Results:Among 3, 815 consecutive patients with severe aortic stenosis (AS) enrolled in the CURRENT AS registry, the study population comprised 2, 005 symptomatic patients, who were subdivided into 3 groups by their treatment strategy and the reasons for conservative strategy (Initial AVR group: n=905; Patient rejection group: n=256; Physician judgment group, n=844). The primary outcome measure was a composite of aortic valve-related death and heart failure hospitalization. Patients in the patient rejection group as compared with those in the physician judgment group were younger, and had less comorbidities, and lower surgical risk scores. The cumulative 5-year incidence of the primary outcome measure in the patient rejection group was markedly higher than that in the initial AVR group, and was similar to that in the physician judgment group (60.7%, 19.0%, and 66.4%, respectively). Conclusions:Patient rejection was the reason for non-referral to AVR in nearly one-quarter of the symptomatic patients with severe AS who were managed conservatively. The dismal outcome in patients who refused AVR was similar to that in patients who were not referred to AVR based on physician judgment despite less comorbidities and lower surgical risk scores in the former than in the latter.
Publisher permitted to deposit this paper on this repository.
DOI(Published Version): 10.1253/circj.CJ-19-0247
PubMed ID: 31316039
Appears in Collections:Journal Articles

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