TY - JOUR T1 - Impact of selected comorbidities on the presentation and management of aortic stenosis JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2020-001271 VL - 7 IS - 2 SP - e001271 AU - Tanja K. Rudolph AU - David Messika-Zeitoun AU - Norbert Frey AU - Jeetendra Thambyrajah AU - Antonio Serra AU - Eberhard Schulz AU - Jiri Maly AU - Marco Aiello AU - Guy Lloyd AU - Alessandro Santo Bortone AU - Alberto Clerici AU - Georg Delle-Karth AU - Johannes Rieber AU - Ciro Indolfi AU - Massimo Mancone AU - Loic Belle AU - Alexander Lauten AU - Martin Arnold AU - Berto J Bouma AU - Matthias Lutz AU - Cornelia Deutsch AU - Jana Kurucova AU - Martin Thoenes AU - Peter Bramlage AU - Richard P. Steeds Y1 - 2020/07/01 UR - http://openheart.bmj.com/content/7/2/e001271.abstract N2 - Background Contemporary data regarding the impact of comorbidities on the clinical presentation and management of patients with severe aortic stenosis (AS) are scarce.Methods Prospective registry of severe patients with AS across 23 centres in nine European countries.Results Of the 2171 patients, chronic kidney disease (CKD 27.3%), left ventricular ejection fraction (LVEF) <50% (22.0%), atrial fibrillation (15.9%) and chronic obstructive pulmonary disease (11.4%) were the most prevalent comorbidities (49.3% none, 33.9% one and 16.8% ≥2 of these). The decision to perform aortic valve replacement (AVR) was taken in a comparable proportion (67%, 72% and 69%, in patients with 0, 1 and ≥2 comorbidities; p=0.186). However, the decision for TAVI was more common with more comorbidities (35.4%, 54.0% and 57.0% for no, 1 and ≥2; p<0.001), while the decision for surgical AVR (SAVR) was decreased with increasing comorbidity burden (31.9%, 17.4% and 12.3%; p<0.001). The proportion of patients with planned AVRs that were performed within 3 months was significantly higher in patients with 1 or ≥2 comorbidities than in those without (8.7%, 10.0% and 15.7%; p<0.001). Furthermore, the mean time to AVR was significantly shorter in patients with one (30.5 days) or ≥2 comorbidities (30.8 days) than in those without (35.7 days; p=0.012). Patients with reduced LVEF tended to be offered an AVR more frequently and with a shorter delay while patients with CKD were less frequently treated.Conclusions Comorbidities in severe patients with AS affect the presentation and management of patients with severe AS. TAVI was offered more often than SAVR and performed within a shorter time period. ER -