Swift intervention with early surgery aids elderly heart patients with aortic stenosis

Until now, patients with aortic stenosis—a narrowing of one of the heart’s main valves—have had to wait until symptoms become severe before undergoing valve replacement. Findings from the EVOLVED study, however, indicate that patients can avoid symptoms such as chest pain, dizziness and fainting if surgery is performed at an earlier stage of the condition.

Researchers say this new approach could also lead to fewer unplanned hospital visits, easing the pressure on an already overstretched health care system.

Aortic stenosis is the most common heart valve disease in developed countries. It is estimated that up to 10 percent of people over 65 have the condition—often caused by a buildup of calcium on the aortic valve over time—with that number increasing with age.

Narrowing of the aortic valve—the heart’s main outlet valve—limits blood flow from the heart to the rest of the body. Over time, it can lead to serious complications, including weakness of the heart muscle which can cause heart failure.

Replacing the aortic valve remains the only treatment option, and a new keyhole approach is now available for many patients who are unable to undergo major surgery.

Experts at the University of Edinburgh set out to explore what difference earlier intervention would have on patients. The EVOLVED study took place across 24 cardiac centers in the UK and Australia and involved 224 patients with severe aortic stenosis but only mild symptoms. The average age of the participants was 73.

They were randomly assigned to either a group that received early intervention in the form of aortic valve replacement or one that received standard monitoring of their condition.

In the early intervention group, 94 percent underwent aortic valve replacement, with the average time from signing up to surgery around five months. In the monitoring group, the average time before surgery was 20 months. About 77 percent eventually had surgery, often due to their symptoms getting worse.

Positive outcomes

Researchers found that just six percent of patients in the early intervention group experienced an unplanned aortic stenosis-related hospitalization, compared to 17 percent in the management group. After one year, 20 percent of participants allocated to early intervention had experienced symptoms related to their condition. That figure was almost double—38 percent—in the group who underwent management.

The study team reported a similar number of deaths in both groups, with most deemed unrelated to their aortic stenosis.

The findings suggest that aortic valve intervention should be offered to patients earlier, in order to prevent the development of symptoms and emergency hospital admissions. These findings should lead to updates in guidelines for doctors, the experts say.

The study is published in the journal JAMA.

“Our study, alongside a similar one carried out in America, suggests that early intervention for severe aortic stenosis can lead to fewer symptoms and hospitalizations. These findings emphasize the importance of timely treatment for patients with this condition, potentially reshaping how doctors approach management strategies in the future,” says Dr. Neil Craig.

“The current evidence supports the consideration of earlier intervention to alleviate symptoms and minimize unplanned hospitalizations. This data challenges the existing treatment plan of delaying intervention until symptom onset. Given that this cohort of patients will likely require intervention regardless, these findings provide a compelling basis for advancing treatment timelines in asymptomatic severe aortic stenosis—an approach that will be well received by patients,” says Professor Vassilios Vassiliou.