TY - JOUR T1 - Management of patients with severe aortic stenosis in the TAVI-era: how recent recommendations are translated into clinical practice JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2020-001485 VL - 8 IS - 1 SP - e001485 AU - Alexander Lauten AU - Tanja K Rudolph AU - David Messika-Zeitoun AU - Jeetendra Thambyrajah AU - Antonio Serra AU - Eberhard Schulz AU - Norbert Frey 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 - Martin Arnold AU - Berto J Bouma AU - Matthias Lutz AU - Cornelia Deutsch AU - Jana Kurucova AU - Martin Thoenes AU - Peter Bramlage AU - Richard Paul Steeds Y1 - 2021/01/01 UR - http://openheart.bmj.com/content/8/1/e001485.abstract N2 - Objective Approximately 3.4% of adults aged >75 years suffer from aortic stenosis (AS). Guideline indications for aortic valve replacement (AVR) distinguish between patients with symptomatic and asymptomatic severe AS. The present analysis aims to assess contemporary practice in the treatment of severe AS across Europe and identify characteristics associated with treatment decisions, namely denial of AVR in symptomatic patients and assignment of asymptomatic patients to AVR.Methods Participants of the prospective, multinational IMPULSE database of patients with severe AS were grouped according to AS symptoms, and stratified into subgroups based on assignment to/denial of AVR.Results Of 1608 symptomatic patients, 23.8% did not undergo AVR and underwent medical treatment. Denial was independently associated with multiple factors, including severe frailty (p=0.024); mitral (p=0.002) or tricuspid (p=0.004) regurgitation grade III/IV, and the presence of renal impairment (p=0.017). Of 392 asymptomatic patients, 86.5% had no prespecified indication for AVR. Regardless, 36.3% were assigned to valve replacement. Those with an indexed aortic valve area (AVA; p=0.045) or left ventricular ejection fraction (LVEF; p<0.001) below the study median; or with a left ventricular end systolic diameter above the study median (p=0.007) were more likely to be assigned to AVR.Conclusions There may be considerable discrepancies between guideline-based recommendations and clinical practice decision-making in the treatment of AS. It appears that guidelines may not fully capture the complete clinical spectrum of patients with AS. Thus, there is a need to find ways to increase their acceptance and the rate of adoption. ER -