Therapeutic Decision-Making for Elderly Patients With Symptomatic Severe Valvular Heart Diseases Ten Years Experience From a Single Centre
Therapeutic Decision-Making for Elderly Patients With Symptomatic Severe Valvular Heart Diseases Ten Years Experience From a Single Centre
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患有症状性严重瓣膜性心脏病的老年患者的治疗决策单中心十年经验
DOI：
10.1536/ihj.16-027
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发表时间：
2016-07-01
影响因子：
1.5
通讯作者：
Wang, Chun Sheng
中科院分区：
文献类型：
--
作者：
Hu, Kui;Wan, Yun;Wang, Chun Sheng
本研究的目的是确定年龄和合并症如何影响老年有症状的严重心脏瓣膜病患者的治疗决策和长期生存。分析了与治疗决策相关的心脏和老年因素，调查了生存结果。116例（64%）患者接受手术治疗（手术组），65例（36%）患者接受保守治疗（保守组）。拒绝手术治疗的最常见[62%（40/65）]原因是最初照顾患者的医生评估的高手术风险。多变量logistic回归分析确定女性、慢性肾功能不全、高龄、肺炎和紧急状态为保守治疗的独立预测因素。孤立性主动脉瓣疾病患者倾向于接受手术。手术组5年生存率为76.8%，保守组为42.9%（P < 0.0001）。在使用倾向评分匹配后，手术组的长期生存率仍高于保守组（P = 0.001）。考克斯回归分析显示保守治疗是所有系列中与不良长期生存相关的单一风险因素，尽管有明确的外科手术指征，但约40%的有症状的严重心脏瓣膜病老年患者仍接受保守治疗。心脏和老年合并症深刻影响治疗决策。应鼓励跨学科讨论，以优化老年心脏瓣膜病患者的治疗方案。
The aim of this study was to determine how older age and co-morbidities affect the treatment decision-making and long-term survival in elderly patients with symptomatic severe valvular heart diseases.A total of 181 elderly patients (mean age, 78.4 +/- 3.4 years) hospitalized between January 2003 and June 2012 with symptomatic severe valvular heart diseases were enrolled. Cardiac and geriatric factors associated with treatment decision-making were analyzed.Survival outcomes were investigated. Surgical treatment was performed in 116 (64%) patients (surgical group) and 65 patients (36%) were treated conservatively (conservative group). The most common [62% (40/65)] reason for refusing surgical treatment was high operative risk as assessed by the physicians who initially cared for the patients. Multivariate logistic regression analysis identified female gender, chronic renal insufficiency, older age, pneumonia, and emergent status as independent predictors of the conservative treatment. Patients with isolated aortic valve disease tended to undergo an operation. Overall 5-year survival in the surgical group was 76.8% versus 42.9% in the conservative group (P < 0.0001). After matching using the propensity score, the surgical group still had a better long-term survival than the conservative group (P = 0.001). Cox regression analysis revealed conservative treatment as the single risk factor associated with poor long-term survival in all series.Approximately 40% of the elderly patients with symptomatic severe heart valve disease were treated conservatively despite a definite indication for surgical intervention. Cardiac and geriatric co-morbidities profoundly affect the treatment decision -making. Interdisciplinary discussion should be encouraged to optimize therapeutic options for elderly patients with valvular heart disease.