Diagnostic and referral delay in patients with aortic stenosis is common and negatively affects outcome
Journal article, 2007
OBJECTIVE: Aortic stenosis (AS) patients are often severely symptomatic at the time of aortic valve replacement (AVR). We wanted to investigate doctors' delay and its impact on outcome. DESIGN: AS patients undergoing AVR (n = 422) were included. Clinical and echocardiographic data at the time of diagnosis and preoperatively were noted. The risk of death after AVR was estimated using Poisson regression, incorporating age, gender, coronary artery disease, NYHA III/IV and time on the waiting list for AVR. RESULTS: The age (mean+/-SD) was 71+/-8.6 years, 45% were women, and 48% were in NYHA III/IV. 55% underwent AVR within one year of diagnosis, indicating late diagnosis. The time from referral to AVR (median, range) was 112 (1-803) days. NYHA III/IV independently predicted mortality (hazard ratio 1.76, 95% CI 1.28-2.43, p = 0.0005). The time from referral to AVR influenced the risk of death immediately after operation (p = 0.0083). CONCLUSION: Late diagnosis and late referral for AVR are common, and negatively influence outcome in patients with AS. Delay in surgery after referral increase the mortality immediately after AVR.
*Waiting Lists
Coronary Angiography
Male
Research Design
*Referral and Consultation
Risk Assessment
*Heart Valve Prosthesis Implantation
Poisson Distribution
Odds Ratio
Severity of Illness Index
Retrospective Studies
Female
Follow-Up Studies
Prognosis
Time Factors
Sweden/epidemiology
Humans
Aged
Kaplan-Meiers Estimate
Aortic Valve Stenosis/*diagnosis/mortality/physiopathology/*surgery
Predictive Value of Tests
Author
Peter Gjertsson
University of Gothenburg
Kenneth Caidahl
University of Gothenburg
Anders Odén
University of Gothenburg
Chalmers, Mathematical Sciences
Odd Bech-Hanssen
University of Gothenburg
Scandinavian Cardiovascular Journal
1401-7431 (ISSN) 1651-2006 (eISSN)
Vol. 41 1 12-8Subject Categories
MEDICAL AND HEALTH SCIENCES
DOI
10.1080/14017430601115935
PubMed
17365972