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Comparative Study
. 2025 Aug 14;12(2):e003405.
doi: 10.1136/openhrt-2025-003405.

Treatment disparities and prognostic implications in octogenarians versus non-octogenarians with high-gradient severe aortic stenosis

Eias Massalha  1   2 , Or Shimoni  2   3 , Olga Rapp  3 , Avi Sabbag  4   2 , Amer Dakka  5 , Robert Klempfner  4   2 , Tal Patalon  6 , Chris Pounds  3 , Amit Segev  4   2
Affiliations
Comparative Study

Treatment disparities and prognostic implications in octogenarians versus non-octogenarians with high-gradient severe aortic stenosis

Eias Massalha et al. Open Heart. .

Abstract

Background: Aortic valve replacement (AVR) is considered one of the most potent disease-modifying procedures among patients with severe aortic stenosis (sAS). Accordingly, we have witnessed a consistent increase in the procedure rates in recent years. Nevertheless, the elderly population, particularly octogenarians, remains relatively undertreated. The current study aims to document the disparities in AVR rates among octogenarians and its prognostic significance.

Methods: A vast database of Maccabi Health Services, the second largest health maintenance organisation in Israel, counting nearly 2.8 million members, was retrospectively analysed from 2005 to 2021 for all patients over 60 years, with a detailed echocardiography report compatible with a diagnosis of high-gradient sAS. The database was extracted using the MDClone healthcare data platform, generating synthetic data reliably representing the original population. All-cause mortality was set to be the primary outcome, and survival models using adjusted multivariable analyses for several clinical and echocardiographic parameters were applied.

Results: The cohort consisted of 1396 patients with high-gradient sAS (76±7 years) with 39% octogenarians. Octogenarians were less likely to undergo AVR (42% vs 60%, p<0.01) and presented more severe clinical profiles. AVR significantly reduced mortality and hospitalisations in both age groups, but octogenarians showed a pronounced survival benefit regardless of symptom status. A time-dependent analysis showed that AVR was associated with reduced all-cause mortality (HR 0.30, 95% CI 0.23 to 0.41, p<0.001) within the octogenarian group in 5 years. A similar protective effect was shown in the non-octogenarian group (HR 0.32, 95% CI 0.22 to 0.46, p<0.001).

Conclusion: This study highlights significant treatment disparities in AVR among octogenarians with high-gradient sAS despite clear benefits in survival and reduced hospitalisations. The findings suggest the need for more inclusive treatment strategies, particularly for older patients, and underscore the importance of AVR in improving clinical outcomes in this population.

Keywords: Aortic Valve Stenosis; Epidemiology; Heart Valve Diseases.

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Conflict of interest statement

Competing interests: OS, OR and CP are employees of Edwards Lifesciences.

Figures

Figure 1
Figure 1. Survival plots in symptomatic and asymptomatic octogenarian patients with high-gradient severe aortic stenosis (AVR and symptoms are time-dependent variables). AVR, aortic valve replacement.
Figure 2
Figure 2. Survival effect of AVR in patients with severe aortic stenosis: subgroup analysis. AVR, aortic valve replacement.
Figure 3
Figure 3. Time to first hospitalisation in octogenarian patients with high-gradient sAS. AVR, aortic valve replacement; sAS, severe aortic stenosis.
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References

    1. Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study. The Lancet. 2006;368:1005–11. doi: 10.1016/S0140-6736(06)69208-8. - DOI - PubMed
    1. Osnabrugge RLJ, Mylotte D, Head SJ, et al. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol. 2013;62:1002–12. doi: 10.1016/j.jacc.2013.05.015. - DOI - PubMed
    1. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021;77:e25–197. doi: 10.1016/j.jacc.2020.11.018. - DOI - PubMed
    1. McDonagh TA, Metra M, Adamo M, et al. Corrigendum to: 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2021;42:3599–726. doi: 10.1093/eurheartj/ehab670. - DOI - PubMed
    1. Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187–98. doi: 10.1056/NEJMoa1103510. - DOI - PubMed

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