Aortic valve replacement was utilized in only 48% of patients with an indication, with significant variation by subtype ranging from 70% in high-gradient to 32% in low-gradient disease (P<0.001).
Cohort (n=10,795)
Yes
What are the temporal trends and predictors of aortic valve replacement utilization among patients with severe aortic stenosis?
Despite the growth in AVR volumes, a substantial proportion of patients with severe aortic stenosis and a clinical indication for AVR remain untreated, particularly those with low-gradient subtypes.
BACKGROUND Despite the rapid growth of aortic valve replacement (AVR) for aortic stenosis (AS), limited data suggest symptomatic severe AS remains undertreated. OBJECTIVES This study sought to investigate temporal trends in AVR utilization among patients with a clinical indication for AVR. METHODS Patients with severe AS (aortic valve area <1 cm2) on transthoracic echocardiograms from 2000 to 2017 at 2 large academic medical centers were classified based on clinical guideline indications for AVR and divided into 4 AS subgroups: high gradient with normal left ventricular ejection fraction (LVEF) (HG-NEF), high gradient with low LVEF (HG-LEF), low gradient with normal LVEF (LG-NEF), and low gradient with low LVEF (LG-LEF). Utilization of AVR was examined and predictors identified. RESULTS Of 10,795 patients, 6,150 (57%) had an indication or potential indication for AVR, of whom 2,977 (48%) received AVR. The frequency of AVR varied by AS subtype with LG groups less likely to receive an AVR (HG-NEF: 70%, HG-LEF: 53%, LG-NEF: 32%, LG-LEF: 38%, P < 0.001). AVR volumes grew over the 18-year study period but were paralleled by comparable growth in the number of patients with an indication for AVR. In patients with a Class I indication, younger age, coronary artery disease, smoking history, higher hematocrit, outpatient index transthoracic echocardiogram, and LVEF ≥0.5 were independently associated with an increased likelihood of receiving an AVR. AVR was associated with improved survival in each AS-subgroup. CONCLUSIONS Over an 18-year period, the proportion of patients with an indication for AVR who did not receive AVR has remained substantial despite the rapid growth of AVR volumes.
Li et al. (Mon,) conducted a cohort in Severe aortic stenosis (n=10,795). Aortic valve replacement was evaluated on Utilization of AVR among patients with an indication or potential indication. Aortic valve replacement was utilized in only 48% of patients with an indication, with significant variation by subtype ranging from 70% in high-gradient to 32% in low-gradient disease (P<0.001).