Predictors of adverse outcomes in medically treated valvular heart disease patients

New York Heart Association (NYHA) functional class III, multiple valve involvement and right ventricular area change predict the incidence of adverse outcomes among medically treated patients with valvular heart disease (VHD), according to a new study presented at the Asian Pacific Society of Cardiology (APSC) 2019 Congress held at the SMX Convention Center in Manila, Philippines.

These adverse outcomes include unscheduled emergency department visit, unscheduled admission, acute decompensated heart failure and mortality, according to study authors Ma. Criselda Nuevo-Ramirez, MD, and Jose Melanio Grayda, MD, both from the Philippine Heart Center.

A total of 246 patients were analysed in the study, of which 36 (14 percent) were noted to have had adverse outcomes. Among the clinical parameters, NYHA functional class III (odds ratio [OR], 6.4; p=0.027) was associated with an increased risk of adverse outcome. [APSC 2019, poster 04]

In terms of echocardiographic parameters, the risk of adverse outcomes was influenced by multiple valve involvement compared with isolated mitral valve disease (mitral and aortic: OR, 12.5; p=0.023; mitral and tricuspid: OR, 9.3; p=0.033; mitral, aortic and tricuspid: OR, 9.7; p=0.032) as well as right ventricular fractional area change (OR, 0.97; p=0.046).

“Only a few contemporary studies enabled spontaneous prognosis to be assessed according to patient characteristics,” the researchers said. “Operative mortality was noted to be predicted using the Euroscore II. However, no scoring system enabled the spontaneous outcome to be assessed for nonoperative mortality and other adverse outcomes.” [Eur Heart J 2007;28:230-268]

Nuevo-Ramirez and Grayda also suggested that recognizing patients at high risk for adverse outcomes might help healthcare providers in deciding which patient would benefit from more aggressive monitoring or earlier intervention.

This prospective cohort study included VHD patients seen at the outpatient department (OPD) and used the OPD logbook for 2014–2017 to identify those that were eligible for inclusion. The researchers interviewed the patients and reviewed charts to obtain clinical, echocardiographic and laboratory data. Follow-up period was 6 months. Composite outcomes were used.

For the study duration, the researchers conducted interval follow-up for outcome monitoring through OPD chart review, phone call or by interview on their next OPD visit. Clinical characteristics of patients were summarized using descriptive statistics. ORs from binary logistic regression were estimated to determine significant predictors for mortality. Missing variables were neither replaced nor estimated.

Nuevo-Ramirez and Grayda said that a larger population and a longer follow-up period are warranted to help identify other predictors of adverse outcomes among medically treated adult VHD patients.

“Evaluation of the prognosis of VHD is derived from studies on natural history, which are frequently old and not always applicable to current presentations,” they noted. [Eur Heart J 2007;28:230-268]