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Title: Usefulness of the Charlson co-morbidity index to predict outcomes in patients >60 years old with aortic stenosis during 18 years of follow-up.
Austin Authors: Kearney, Leighton G ;Ord, Michelle;Buxton, Brian F ;Matalanis, George ;Patel, Sheila K ;Burrell, Louise;Srivastava, Piyush M 
Affiliation: Department of Cardiology, Austin Health, Victoria, Australia
Issue Date: 25-May-2012
Publication information: The American Journal of Cardiology 2012; 110(5): 695-701
Abstract: The present study assessed the effect of age and co-morbidity on the outcomes of mild, moderate, and severe aortic stenosis (AS) in patients aged >60 years during 18 years of follow-up. The outcomes evaluated were hemodynamic progression, a composite cardiac mortality or aortic valve replacement (AVR) end point, and all-cause mortality. Consecutive Department of Veterans Affairs patients (aged >60 years) with AS were prospectively enrolled from 1988 to 1994 and followed until 2008 (n = 239). The baseline demographic, co-morbidity, and echocardiographic parameters were recorded. At enrollment, the mean age was 74 ± 6 years, and 78% were men. The annualized mean aortic valve gradient progression was 4 ± 4, 6 ± 5, and 10 ± 8 mm Hg for mild, moderate, and severe AS, respectively (p <0.001). During a mean follow-up of 8 ± 5 years, 206 deaths (52% cardiac) and 91 AVRs were recorded. The AVR/cardiac mortality event rate at 1, 5, and 10 years was 2%, 26%, and 50% for mild AS, 13%, 63%, and 69% for moderate AS, and 66%, 95%, and 95% for severe AS (p <0.001). During the study period, 132 patients developed severe AS. The survival rate at 1, 5, and 10 years was 60 ± 7%, 14 ± 5%, and 5 ± 3% with conservative management and 98 ± 2%, 82 ± 4%, and 50 ± 5% after AVR, respectively (p <0.001). The independent predictors of all-cause mortality were the age-adjusted Charlson co-morbidity index (hazard ratio 1.24, p <0.001), AVR (hazard ratio 0.40, p <0.001), and grade of left ventricular dysfunction (hazard ratio 1.36, p = 0.01). In conclusion, the prognostic significance of AS is determined by the hemodynamic severity, left ventricular function, and the presence of symptoms, in the context of age and co-morbidities. The age-adjusted Charlson co-morbidity index provides crucial prognostic information to guide the surgical risk/benefit discussions for patients with severe AS.
Gov't Doc #: 22632826
DOI: 10.1016/j.amjcard.2012.04.054
Journal: The American journal of cardiology
Type: Journal Article
Subjects: Age Distribution
Aged, 80 and over
Analysis of Variance
Aortic Valve
Cohort Studies
Disease-Free Survival
Follow-Up Studies
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation.methods.mortality
Kaplan-Meier Estimate
Multivariate Analysis
Outcome Assessment (Health Care).methods
Postoperative Complications.epidemiology.physiopathology
Predictive Value of Tests
Proportional Hazards Models
Prospective Studies
Severity of Illness Index
Sex Distribution
Survival Analysis
Treatment Outcome
Ultrasonography, Doppler.methods
Appears in Collections:Journal articles

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