Early Surgery Aids Elderly Heart Patients with Aortic Stenosis, Finds Study

By HospiMedica International staff writers
Posted on 05 Nov 2024

Image: Swift intervention aids elderly heart patients (Photo courtesy of Shutterstock)

Aortic stenosis, which is the narrowing of one of the heart's primary valves, is the most prevalent heart valve disease in developed nations. It is estimated that approximately 10% of individuals over the age of 65 are affected by this condition, often resulting from a gradual accumulation of calcium on the aortic valve, with prevalence increasing with age. The narrowing of the aortic valve, which serves as the heart's main outlet valve, restricts blood flow from the heart to the rest of the body. Over time, this can result in serious complications, including weakening of the heart muscle, potentially leading to heart failure. While replacing the aortic valve is the sole treatment option, a new minimally invasive approach is now available for many patients who cannot undergo major surgery. However, until now, patients with aortic stenosis had to wait until their symptoms became severe before receiving valve replacement. Now, findings from a study published in JAMA indicate that performing surgery at an earlier stage can help patients avoid symptoms such as chest pain, dizziness, and fainting. Researchers suggest that this new strategy could also result in fewer unplanned hospital visits, thereby alleviating some of the strain on an already overwhelmed healthcare system.

To examine the impact of earlier intervention, researchers from The University of Edinburgh (Scotland, UK) conducted the EVOLVED study across 24 cardiac centers in the UK and Australia, involving 224 patients with severe aortic stenosis but only mild symptoms. The average age of the participants was 73. They were randomly divided into two groups: one receiving early intervention in the form of aortic valve replacement and the other undergoing standard monitoring of their condition. Among those in the early intervention group, 94% underwent aortic valve replacement, with an average time of about five months from enrollment to surgery. Conversely, the monitoring group waited an average of 20 months before surgery, with around 77% ultimately requiring surgery due to worsening symptoms.

The researchers discovered that only 6% of patients in the early intervention group experienced unplanned hospitalizations related to aortic stenosis, compared to 17% in the monitoring group. After one year, 20% of participants in the early intervention group had developed symptoms associated with their condition, whereas this figure was nearly doubled—38%—in the management group. The study team noted that the number of deaths was similar in both groups, with most deaths not linked to aortic stenosis. These findings indicate that earlier aortic valve intervention should be offered to patients to prevent the onset of symptoms and emergency hospital admissions. Experts believe these results should prompt updates to guidelines for healthcare providers.

“Our study, alongside a similar one carried out in America, suggests that early intervention for severe aortic stenosis can lead to fewer symptoms and hospitalizations,” said Dr. Neil Craig, Clinical Research Fellow at the University of Edinburgh and a cardiology doctor. “These findings emphasize the importance of timely treatment for patients with this condition, potentially reshaping how doctors approach management strategies in the future.”

“The current evidence supports the consideration of earlier intervention to alleviate symptoms and minimize unplanned hospitalizations,” added Professor Vassilios Vassiliou, Clinical Professor of Cardiac Medicine at the University of East Anglia and co-author on the paper. “This data challenges the existing treatment plan of delaying intervention until symptom onset. Given that this cohort of patients will likely require intervention regardless, these findings provide a compelling basis for advancing treatment timelines in asymptomatic severe aortic stenosis – an approach that will be well received by patients.”