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Severe aortic stenosis in frailty — SCE Geriatric Medicine MCQ

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HardCardiovascular medicineSevere aortic stenosis in frailtySCE Geriatric Medicine

An 86-year-old woman has progressive exertional dyspnoea and a harsh ejection systolic murmur radiating to the carotids. She has frailty, CKD3 and mild cognitive impairment but lives independently. Echocardiography shows severe calcific aortic stenosis with preserved LV function. What is the most appropriate management?

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Correct answer: E — Refer to the valve multidisciplinary team for assessment including frailty, cognition and treatment goals

Symptomatic severe aortic stenosis has poor prognosis without valve intervention, but treatment choice should be individualised through a valve MDT considering frailty, cognition, anatomy and goals. Chronological age alone should not exclude TAVI or surgery. Medical therapy does not correct fixed outflow obstruction. The pearl is that geriatric assessment helps distinguish frailty that changes procedural planning from futility.

Reference: NICE NG208; ESC valvular heart disease guidance