- Of 200 asymptomatic patients with severe aortic stenosis, 140 (70%) adhered to guidelines of serial evaluations every 12 months over 3 years of follow up. - Patients adhering to guidelines had aortic valve replacement more frequently (47.2% vs 18.3%; p=0.001) and lower incidence of heart failure hospitalization (59.2% vs 52.6%; p=0.02) compared to non-adherent patients. - There was no difference in mortality or inpatient costs between adherent and non-adherent groups. Adherence to guidelines was associated with greater rates of aortic valve replacement and reduced heart failure hospitalization without impacting survival or costs.