Aortic stenosis: benefits of early intervention

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Until now, patients with aortic stenosis – a narrowing of one of the heart’s main valves – have had to wait until symptoms become severe before undergoing valve replacement. Findings from the EVOLVED study, however, indicate that patients can avoid symptoms such as chest pain, dizziness and fainting if surgery is performed at an earlier stage of the condition. Researchers from the University of Edinburgh and the University of East Anglia (UEA) say this new approach could also lead to fewer unplanned hospital visits, easing the pressure on an already overstretched healthcare system. 

The findings were published in JAMA. 

Aortic stenosis is the most common heart valve disease in developed countries. It is estimated that up to 10% of people over 65 have the condition – often caused by a buildup of calcium on the aortic valve over time – with that number increasing with age. Narrowing of the aortic valve – the heart’s main outlet valve – limits blood flow from the heart to the rest of the body. Over time, it can lead to serious complications, including weakness of the heart muscle which can cause heart failure. Replacing the aortic valve remains the only treatment option, and a new keyhole approach is now available for many patients who are unable to undergo major surgery.

Experts set out to explore what difference earlier intervention would have on patients. The EVOLVED study took place across 24 cardiac centres in the UK and Australia and involved 224 patients with severe aortic stenosis but only mild symptoms. The average age of the participants was 73. They were randomly assigned to either a group that received early intervention in the form of aortic valve replacement or one that received standard monitoring of their condition. In the early intervention group, 94% underwent aortic valve replacement, with the average time from signing up to surgery around five months. In the monitoring group, the average time before surgery was 20 months. About 77% eventually had surgery, often due to their symptoms getting worse. 

Researchers found that just 6% of patients in the early intervention group experienced an unplanned aortic stenosis-related hospitalisation, compared to 17% in the management group. After one year, 20% of participants allocated to early intervention had experienced symptoms related to their condition. That figure was almost double – 38% – in the group who underwent management. The study team reported a similar number of deaths in both groups, with most deemed unrelated to their aortic stenosis. 

The findings suggest that aortic valve intervention should be offered to patients earlier, to prevent the development of symptoms and emergency hospital admissions. These findings should lead to updates in guidelines for doctors, the experts say. Dr Neil Craig, Clinical Research Fellow at the University of Edinburgh and a cardiology doctor, said: “Our study, alongside a similar one carried out in America, suggests that early intervention for severe aortic stenosis can lead to fewer symptoms and hospitalisations. These findings emphasise the importance of timely treatment for patients with this condition, potentially reshaping how doctors approach management strategies in the future.” 

Professor Vassilios Vassiliou, a co-author of the study from UEA’s Norwich Medical School, said: “The current evidence supports the consideration of earlier intervention to alleviate symptoms and minimise unplanned hospitalisations. 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.” 

Source: University of East Anglia

03.11.2024

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