Why do so few older people with aortic stenosis have valve replacement surgery?

Abstract

Background: many older patients with severe aortic stenosis do not have valve replacement surgery. Objective: to determine the proportion of older people with symptomatic aortic stenosis referred for specialist assessment and the reasons for non-referral. Methods: retrospective study of all patients over 75 attending the geriatric department of an English teaching hospital. Confirmation was by reviewing all echocardiographic reports. Results: of 40 patients with symptomatic aortic stenosis, only four had undergone surgery. Seven patients refused operation; five were medically unfit (for reasons other than heart failure) and reasons for not referring could not be found in 13 casenotes. Of the 15 patients referred to a cardiologist, eight were considered suitable for surgery. Conclusion: only one in five patients over 75 with echocardiographicaly-confirmed aortic stenosis was considered for surgery. Prospective studies are needed to determine why patients and geriatricians do not seek specialist assessment for this treatable condition.