Why do so few older people with aortic stenosis have valve replacement surgery?

Background: many older patients with severe aortic stenosis do not have valve replacement surgery. Objective: to determine the proportion of older people with symptomatic aortic stenosis referred for specialist assessment and the reasons for non-referral. Methods: retrospective study of all patients over 75 attending the geriatric department of an English teaching hospital, Confirmation was by reviewing all echocardiographic reports. Results: of 40 patients with symptomatic aortic stenosis, only four had undergone surgery. Seven patients refused operation, five were medically unfit (for reasons other than heart failure) and reasons for not referring could not be found in 13 casenotes. Of the 15 patients referred to a cardiologist, eight were considered suitable for surgery. Conclusion: only one in five patients over 75 with echocardiographically-confirmed aortic stenosis was considered for surgery. Prospective studies are needed to determine why patients and geriatricians do not seek specialist assessment for this treatable condition.