Aortic stenosis prognosis in older patients: frailty is a strong marker of early congestive heart failure admissions : Influence of frailty in aortic stenosis.

Abstract

Degenerative aortic stenosis has become a new valvular epidemic in the last few decades due to its high prevalence in the geriatric population. We sought to analyse factors that could influence earlier hospitalization for congestive heart failure in geriatric patients with moderate-severe degenerative aortic stenosis. This investigation was an ambispective cohort study of 104 patients aged 70years or older with moderate-severe aortic stenosis. Epidemiological, geriatric, clinical, echocardiographic and electrocardiographic variables were collected. During the follow-up, the number of admissions for congestive heart failure and the time elapsed from diagnosis to first admission were recorded. A total of 45.2% of the patients were admitted for congestive heart failure, with a median time to first admission of 3years (95% CI 1.88-4.25). For patients aged 85years or older, this median was 8.07months (95% CI 0.05-1.99). The first admission for congestive heart failure was independently related to frailty (HR 4.46, 95% CI: 1.38-14.41), atrial fibrillation (HR 2.19, 95% CI: 1.01-4.73), a high EuroSCORE (HR 1.03, 95% CI: 1.00-1.05), the affected valvular area (HR 0.11, 95% CI: 0.02-0.47), age (HR 1.11, 95% CI: 1.04-1.18) and renal failure (HR 4.13, 95% CI: 1.46-11.63). The median time to admission for frail patients was 1.08years (95% CI 0.30-1.86). In geriatric patients with moderate-severe degenerative aortic stenosis, frailty is an independent marker of early congestive heart failure admission with a powerful and important association.