{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T09:39:13Z","timestamp":1762508353432,"version":"3.44.0"},"reference-count":32,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,1,11]],"date-time":"2021-01-11T00:00:00Z","timestamp":1610323200000},"content-version":"unspecified","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006520","name":"Edwards Lifesciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006520","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2020,12,21]]},"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Approximately 3.4% of adults aged &gt;75 years suffer from aortic stenosis (AS). Guideline indications for aortic valve replacement (AVR) distinguish between patients with symptomatic and asymptomatic severe AS. The present analysis aims to assess contemporary practice in the treatment of severe AS across Europe and identify characteristics associated with treatment decisions, namely denial of AVR in symptomatic patients and assignment of asymptomatic patients to AVR.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Participants of the prospective, multinational IMPULSE database of patients with severe AS were grouped according to AS symptoms, and stratified into subgroups based on assignment to\/denial of AVR.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 1608 symptomatic patients, 23.8% did not undergo AVR and underwent medical treatment. Denial was independently associated with multiple factors, including severe frailty (p=0.024); mitral (p=0.002) or tricuspid (p=0.004) regurgitation grade III\/IV, and the presence of renal impairment (p=0.017). Of 392 asymptomatic patients, 86.5% had no prespecified indication for AVR. Regardless, 36.3% were assigned to valve replacement. Those with an indexed aortic valve area (AVA; p=0.045) or left ventricular ejection fraction (LVEF; p&lt;0.001) below the study median; or with a left ventricular end systolic diameter above the study median (p=0.007) were more likely to be assigned to AVR.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>There may be considerable discrepancies between guideline-based recommendations and clinical practice decision-making in the treatment of AS. It appears that guidelines may not fully capture the complete clinical spectrum of patients with AS. Thus, there is a need to find ways to increase their acceptance and the rate of adoption.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2020-001485","type":"journal-article","created":{"date-parts":[[2021,1,11]],"date-time":"2021-01-11T18:07:18Z","timestamp":1610388438000},"page":"e001485","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Management of patients with severe aortic stenosis in the TAVI-era: how recent recommendations are translated into clinical practice"],"prefix":"10.1136","volume":"8","author":[{"given":"Alexander","family":"Lauten","sequence":"first","affiliation":[{"name":"Department for Cardiology, Helios Clinic, Erfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanja K","family":"Rudolph","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hear and Diabetes Center Bad Oeynhausen, Ruhr-University of Bochum, Bad Oeynhausen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6278-5670","authenticated-orcid":false,"given":"David","family":"Messika-Zeitoun","sequence":"additional","affiliation":[{"name":"University of Ottawa Heart Institute, Ottawa, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeetendra","family":"Thambyrajah","sequence":"additional","affiliation":[{"name":"James Cook University Hospital, Middlesbrough, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Serra","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalunya, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eberhard","family":"Schulz","sequence":"additional","affiliation":[{"name":"Cardiology Department, AKH Celle, Celle, Niedersachsen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norbert","family":"Frey","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, University of Kiel, Kiel, Schleswig-Holstein, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiri","family":"Maly","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic"},{"name":"Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University, Prague, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Aiello","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Foundation IRCCS Policlinico S.Matteo, Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guy","family":"Lloyd","sequence":"additional","affiliation":[{"name":"St Bartholomew's Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro Santo","family":"Bortone","sequence":"additional","affiliation":[{"name":"University of Bari, Bari, Puglia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Clerici","sequence":"additional","affiliation":[{"name":"University of Turin, Turin, Piemonte, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georg","family":"Delle-Karth","sequence":"additional","affiliation":[{"name":"4th Medical Department, Hietzing Hospital, Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Rieber","sequence":"additional","affiliation":[{"name":"Herzkatheterlabor Nymphenburg and Department of Cardiology, University of Munich, Munich, Bayern, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ciro","family":"Indolfi","sequence":"additional","affiliation":[{"name":"Division of Cardiology and URT CNR of IFC, University Magna Graecia, Catanzaro, Calabria, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massimo","family":"Mancone","sequence":"additional","affiliation":[{"name":"Sapienza University of Rome, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loic","family":"Belle","sequence":"additional","affiliation":[{"name":"Centre Hospital d\u2019Annecy, Annecy, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Arnold","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Erlangen, Erlangen, Bayern, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Berto J","family":"Bouma","sequence":"additional","affiliation":[{"name":"University of Amsterdam, Amsterdam, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Lutz","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, University of Kiel, Kiel, Schleswig-Holstein, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cornelia","family":"Deutsch","sequence":"additional","affiliation":[{"name":"Institut f\u00fcr Pharmakologie und Pr\u00e4ventive Medizin GmbH, Cloppenburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jana","family":"Kurucova","sequence":"additional","affiliation":[{"name":"Edwards Lifesciences, Prague, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Thoenes","sequence":"additional","affiliation":[{"name":"Edwards Lifesciences, Nyon, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4970-2110","authenticated-orcid":false,"given":"Peter","family":"Bramlage","sequence":"additional","affiliation":[{"name":"Institut f\u00fcr Pharmakologie und Pr\u00e4ventive Medizin GmbH, Cloppenburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5687-2535","authenticated-orcid":false,"given":"Richard Paul","family":"Steeds","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital & Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,1,11]]},"reference":[{"key":"2025081709525653000_8.1.e001485.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs109"},{"key":"2025081709525653000_8.1.e001485.2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx391"},{"key":"2025081709525653000_8.1.e001485.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1912846"},{"key":"2025081709525653000_8.1.e001485.4","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi471"},{"key":"2025081709525653000_8.1.e001485.5","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.82.2.143"},{"key":"2025081709525653000_8.1.e001485.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12872-016-0439-4","article-title":"Quality of care assessment and improvement in aortic stenosis - rationale and design of a multicentre registry (IMPULSE)","volume":"17","author":"Frey","year":"2017","journal-title":"BMC Cardiovasc Disord"},{"key":"2025081709525653000_8.1.e001485.7","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2019-314940"},{"key":"2025081709525653000_8.1.e001485.8","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.119.013160","article-title":"Facilitated data relay and effects on treatment of severe aortic stenosis in Europe","volume":"8","author":"Steeds","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"2025081709525653000_8.1.e001485.9","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/10.1_Part_1.20"},{"key":"2025081709525653000_8.1.e001485.10","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1161\/CIRCULATIONAHA.119.041080","article-title":"Contemporary presentation and management of valvular heart disease: the EURObservational research programme valvular heart disease II survey","volume":"140","author":"Iung","year":"2019","journal-title":"Circulation"},{"key":"2025081709525653000_8.1.e001485.11","doi-asserted-by":"crossref","first-page":"823","DOI":"10.4244\/EIJV12I7A136","article-title":"The scientific value of TAVI surveys: insights and perspectives from European centres and European patients","volume":"12","author":"Ludman","year":"2016","journal-title":"EuroIntervention"},{"key":"2025081709525653000_8.1.e001485.12","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39478.498819.AD"},{"key":"2025081709525653000_8.1.e001485.13","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.113.000650"},{"key":"2025081709525653000_8.1.e001485.14","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1007\/s00392-017-1151-9","article-title":"Transcatheter aortic valve implantation in patients with a reduced left ventricular ejection fraction: a single-centre experience in 2000 patients (TAVIK registry)","volume":"106","author":"Schymik","year":"2017","journal-title":"Clin Res Cardiol"},{"key":"2025081709525653000_8.1.e001485.15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0027556"},{"key":"2025081709525653000_8.1.e001485.16","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.929893"},{"key":"2025081709525653000_8.1.e001485.17","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.114.002917"},{"key":"2025081709525653000_8.1.e001485.18","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.079350"},{"key":"2025081709525653000_8.1.e001485.19","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1308\/003588412X13171221591817","article-title":"Unoperated severe aortic stenosis: decision making in an adult UK-based population","volume":"94","author":"Badran","year":"2012","journal-title":"Ann R Coll Surg Engl"},{"key":"2025081709525653000_8.1.e001485.20","doi-asserted-by":"crossref","first-page":"283","DOI":"10.2174\/1573403X13666170804151608","article-title":"Impact of pre-existing kidney dysfunction on outcomes following transcatheter aortic valve replacement","volume":"13","author":"Ifedili","year":"2017","journal-title":"Curr Cardiol Rev"},{"key":"2025081709525653000_8.1.e001485.21","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.004961"},{"key":"2025081709525653000_8.1.e001485.22","first-page":"C232","article-title":"Improvement in renal functions with transcatheter aortic valve implantation","volume":"10","author":"Kele\u015f","year":"2013","journal-title":"J Geriatr Cardiol"},{"key":"2025081709525653000_8.1.e001485.23","doi-asserted-by":"crossref","first-page":"1464.e1","DOI":"10.1016\/j.amjmed.2017.05.031","article-title":"Outcomes of transcatheter and surgical aortic valve replacement in patients on maintenance dialysis","volume":"130","author":"Alqahtani","year":"2017","journal-title":"Am J Med"},{"key":"2025081709525653000_8.1.e001485.24","doi-asserted-by":"publisher","DOI":"10.1007\/s12471-011-0224-z"},{"key":"2025081709525653000_8.1.e001485.25","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.maturitas.2015.06.033","article-title":"Determinants in treatment decision-making in older patients with symptomatic severe aortic stenosis","volume":"82","author":"Boureau","year":"2015","journal-title":"Maturitas"},{"key":"2025081709525653000_8.1.e001485.26","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.001822"},{"key":"2025081709525653000_8.1.e001485.27","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.114.002073"},{"key":"2025081709525653000_8.1.e001485.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.06.024"},{"key":"2025081709525653000_8.1.e001485.29","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2014.03.014"},{"key":"2025081709525653000_8.1.e001485.30","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.001290"},{"key":"2025081709525653000_8.1.e001485.31","doi-asserted-by":"crossref","first-page":"192","DOI":"10.4330\/wjc.v8.i2.192","article-title":"Diagnosis and management of patients with asymptomatic severe aortic stenosis","volume":"8","author":"Katayama","year":"2016","journal-title":"World J Cardiol"},{"key":"2025081709525653000_8.1.e001485.32","unstructured":"Schymik G . Early and late outcomes after TAVI in asymptomatic patients with severe aortic stenosis from the source XT registry. EuroIntervention, 2014."}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2020-001485","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T16:53:06Z","timestamp":1755449586000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2020-001485"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1,11]]},"published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.1136\/openhrt-2020-001485"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2020-001485","relation":{},"ISSN":["2053-3624"],"issn-type":[{"type":"electronic","value":"2053-3624"}],"subject":[],"published":{"date-parts":[[2021,1]]}}}