Decision analysis on treatment strategies for patients aged 75 years and over with severe valvular heart diseases

Objective To summarize the treatment decision-making strategy and its long-term efficacy for advanced elderly patients with severe valvular heart disease and clear indications for surgery. Methods Clinical data of 196 patients aged 75 years and older firmly diagnosed as severe valvular heart diseases were retrospectively analyzed.The patients were divided into the surgical group(a mean age of 77.4±2.0 years, n=126)and the conservative group(a mean age of 80.5±5.0 years, n=70). Factors affecting therapeutic decision-making were analyzed, and the differences in a long-term survival were compared between the two groups. Results The most common reason for choosing conservative treatment was the recommendation of the doctor giving a preliminary diagnosis and worrying about the high-risk surgery for the patients(62.9%, 44/70). Only 26(37.1%)patients in the conservative group were evaluated by cardiac surgeons, among whom 12(17.1%)patients were considered to have surgical contraindications, and 14(20.0%)patients themselves or their family members chose conservative treatment for the fear of surgical risks.Patients in the operation group were mainly from the outpatient department of cardiac surgery, and only 8(6.3%)cases were referred from department of internal medicine.Logistic regression analysis showed that female, chronic renal insufficiency, advanced age, pneumonia and emergency hospital admissions were independent predictors for the conservative option(P<0.01), while patients with isolated aortic valve disease tended to receive surgical treatment.Overall 5-year survival was higher in the surgical group than in the conservative group(76.4% vs.39.9%, P<0.01). Cox regression analysis disclosed that the conservative treatment option was the single risk factor for long-term survival in all series. Conclusions Many factors affect the process of therapeutic decision-making for patients with severe valvular heart diseases, and a multidisciplinary collaboration is the best way for the optimal treatment strategy for those patients. Key words: Heart valve diseases; Clinical protocols