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Risk willingness and survival in patients with severe aortic stenosis.

Session Poster Session 3

Speaker Amjad Hussain

Congress : Heart Failure 2019

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Valvular Heart Disease - Treatment
  • Session type : Poster Session
  • FP Number : P1806

Authors : AI Hussain (Oslo,NO), C Brunborg (Oslo,NO), A Auensen (Oslo,NO), JO Beitnes (Oslo,NO), L Gullestad (Oslo,NO), KIP Pettersen (Oslo,NO)

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Authors:
AI Hussain1 , C Brunborg2 , A Auensen1 , JO Beitnes1 , L Gullestad1 , KIP Pettersen1 , 1Oslo University Hospital, Cardiology - Oslo - Norway , 2Oslo University Hospital, Department of Biostatistics and Epidemiology - Oslo - Norway ,

Citation:

Background: Standard Gamble (SG) is a validated tool for assessing patient preferences of treatment. SG derived risk willingness (RW) scores takes into account the notion of risk adhered to the intervention and uncertainty of the outcome, making it well suited to be used in patients with severe aortic stenosis (AS) referred for evaluation of aortic valve replacement (AVR). We anticipated an association between preoperatively assessed risk willingness and survival, but that the association would differ in strength depending on whether patients were operated or not.

Method: Consecutive patients > 18 years with severe AS were preoperatively examined with echocardiography, blood sampling, quality of life questionnaires, functional test, and SG.  All patient assessment, including SG was done before and blinded to the treatment decision made by The Heart team. Patients with a Mini Mental Score less than 24 were excluded from this analysis.  All-cause mortality data were collected at 5 years after the initial time of decision or intervention. We used the median RW score in the total sample (25%) as a cut of to compare patients with high and low RW.

Results:  Overall, 439 patients were included, 365 patients underwent AVR while 74 patients were medically treated (med-treated). Operated patients had a higher RW-score score as compared to med-treated patients; 30% IQR (7-50%) vs. 12.5% IQR (1-40%), respectively, p< 0,005. There was no association between RW and 5-year survival in patients undergoing AVR (Fig. 1), while in the med-treated group ; patients with low risk willingness had higher survival compared to those with high risk willingness , (1229 ±98) vs. (903±111), p=0.035 respectively (days) (Fig. 2). A Cox regression analyses showed that higher RW was associated with increased mortality also when adjusted for gender, NYHA class and NT-proBNP at baseline in the medically treated group.

Conclusion:  Patients with severe AS and higher risk willingness are more likely to undergo AVR.  The risk willingness is associated with survival only in medically treated patients with severe AS.  Patient’s risk willingness adds to our knowledge of survival in medically treated patients additionally to established disease markers as NYHA class and NT-proBNP.



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