Four options for managing aortic stenosis disease progression
By ShareMD Connect
Aortic stenosis is usually a progressive disease, meaning that it gets worse over time. It won’t go away on its own, and if it progresses to a severe state with congestive heart failure complications, treatment can become an urgent decision.
But until your aortic stenosis becomes severe, your doctor may offer you a choice in treatment paths. This type of medical approach is called shared decision-making, and it empowers you to take control of your health and choose what’s right for you.
Choosing your treatment path can be overwhelming. Generally speaking, there are four options to choose from as your disease progresses. They are:
- Watch and wait
- Symptom management with medication
- Surgery to replace the valve
- Palliative care
Watch and wait
If your aortic stenosis is classified as mild or asymptomatic, your physician may recommend a “watch and wait” approach. That means you won’t take any interventional steps right now, but you will get routine tests to monitor the disease’s progression.
Watch and wait can be a good choice for many low-risk people. However, it is important that you still actively manage your disease.
The most recent 2020 American Heart Association Guidelines state that even in asymptomatic mild-moderate disease, patients should be monitored serially with specific testing and assessment of symptoms such as exercise tolerance.
While it’s important that you listen to your body and notify your doctor of any new symptoms, it’s equally critical that you push your providers to consistently run all necessary tests, including echocardiograms, to monitor your condition appropriately.
Symptom management with medication
Medications can be part of an effective treatment plan for mild to moderate aortic stenosis.
Some medications can decrease cardiovascular risk by lowering blood pressure, managing cholesterol, thinning the blood, and more, which can help you live longer. Others, like diuretics, can treat symptoms of heart failure. But medication alone cannot cure severe aortic stenosis and will not prevent your disease from progressing.
Medication management can be a good treatment choice for someone suffering from other health problems or someone who is considered too high risk for surgery.
But as your disease progresses, you may find that medication is no longer the right treatment for you. It’s important that you have routine check-ups with your cardiology specialist to monitor ongoing disease progression and reassess your medications.
Surgery to replace the valve
Surgical valve replacement is the only proven treatment for aortic stenosis and is often the treatment of choice for those with severe disease.
However, research shows that up to 40% of people with severe, symptomatic aortic stenosis do not undergo surgery for valve replacement, despite what clinical guidelines recommend.
By the time your disease has progressed to “severe,” you should be in conversations with your doctor to learn whether or not surgery is an option for you. It’s important that you ask your doctor if you’re a candidate for either TAVR or SAVR or both.
Understanding the differences between the two procedures can help you make an informed decision. If surgery isn’t an option, or it’s not something you want to do, make sure you understand what that means for your disease progression.
Palliative care
For some people, surgery isn’t an option, or it’s not something you want to do. In these cases, if your disease has progressed to “severe, " it is sometimes best to discuss palliative care options with your physician. Contrary to popular belief, this does not mean you have to stop receiving treatment for your disease.
Palliative care is a treatment that aims to make you as comfortable as possible living with your disease. The goal is to maximize your quality of life, improve symptoms, and ensure the continuity of health services.
Palliative care priorities include treating pain, other symptoms, and psychological and spiritual distress. It uses advanced communication skills to establish goals of care and help match treatment options to individualized goals while providing coordinated care to ensure continuity. It adds a layer of support to patients, their loved ones, and treating clinicians.
If palliative care is an option you want to explore, discuss it with your doctor. Your current physician may not be trained to provide palliative medicine, so they may bring in a support team of specialists to ensure you receive the best care possible.
Aortic stenosis is usually a progressive disease. It’s important to understand the options you have to manage your condition as it moves through mild, moderate, and severe stages. Your doctor should help you be as proactive as possible, but if you’re looking for an extra layer of support to help you navigate your aortic stenosis, consider talking to a ShareMD nurse who can answer your questions and connect you with quality care.