Half of eligible patients are not getting aortic valve replacement due to fear of surgery

Fear about the risk of surgery is among the reasons half of eligible patients are not getting aortic valve replacement surgery, according to a study by physicians at the University of Michigan Health System.

Earlier this year, former First Lady Barbara Bush and comedian Robin Williams underwent aortic valve replacement surgery, but many patients may be missing out on the potentially life-saving surgery.

In the study published online ahead of print Nov. 17 in Circulation: Cardiovascular Quality and Outcomes, two-thirds of the patients who did not have valve replacement were suffering symptoms such as shortness of breath that would have improved if they had the surgery.

"Aortic valve replacement not only treats the symptoms, but also saves lives," says lead author David S. Bach, M.D., professor of internal medicine at the U-M Medical School and cardiologist at the U-M Cardiovascular Center.

Aortic stenosis, a narrowing of the aortic valve opening, is common among older adults. In those age 75 and older, as many as 5 percent have the heart condition.

Over time, the heart thickens as it tries to pump blood through the small valve opening which can lead to heart failure. People with severe aortic stenosis may have shortness of breath, chest discomfort, or lose consciousness due to the low blood flow across the valve.

Authors say they were surprised to learn that more than a handful of patients were denied surgery.

Researchers identified 369 patients from three Michigan hospitals who had aortic stenosis. They had been screened by electrocardiogram. Among them, 191 did not have their aortic valve replaced.

The lack of referrals for surgery occurred in a variety of settings - whether patients saw a community physician or one affiliated with a university or veterans hospital - which suggests a widespread lack of awareness about the benefits of surgery, or overestimation of the risks associated with the surgery.

A review of patient charts showed the most common reasons for not referring for surgery was surgical risk and presence of other major health problems.

But surgical risk scores for patients who did not have surgery were lower than doctors had predicted, according to surgical risk guidelines created by the Society of Thoracic Surgery.

Surgery is considered the best treatment for aortic stenosis and the consequences of waiting or passing up surgery are substantial. Only 66 percent of the patients who did not undergo surgery survived 12 months later.

Bach suggests cardiologists become more familiar with guideline recommendations and the data on which they are based, discuss options more fully with patients, and when possible, involve a cardiac surgeon in consultation.