Impact of Managing Provider Type on Severe Aortic Stenosis Management and Mortality

Figures

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  Figure 1. Consort diagram. AVR indicates aortic valve replacement; PCP, primary care provider; and sAS, severe aortic stenosis. aDefining criteria for sAS were a mean pressure gradient ≥40 mm Hg, aortic valve area <1.0 cm2, or peak velocity ≥ 4.0 m/s; and a current or prior diagnosis code indicating aortic stenosis. bPatients were included if the date of aortic stenosis diagnosis by International Classification of Diseases, Tenth Revision (ICD‐10) code was at any point on or before the date of echocardiography detecting sAS. cLack of data continuity was defined as no evidence of an outpatient/pharmacy encounter or death within ±1 year of echocardiography detecting sAS. dFollow‐up period: 1 to 365 days after echocardiography detecting sAS. eA PCP was identified as the managing provider if Optum EHR data indicated an outpatient visit with 1 of the study's selected PCP provider types, and no cardiac specialist visit, in the year before echocardiography detecting sAS. fA cardiac specialist was identified as the managing provider if Optum EHR data indicated an outpatient visit with 1 of the study's selected cardiac specialist types in the year before echocardiography detecting sAS.

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  Figure 2. Association of cardiac specialist follow‐up with managing provider type for patients with severe aortic stenosis. Plot based on adjusted Cumulative Incidence Function and HR based on cause‐specific hazard model. Covariates include age, sex, White race, region, payor, 28 Elixhauser comorbidity indicators, symptomatic indicator, and year of severe aortic stenosis diagnosis. The colored shading around each curve represents the 95% CI. AS indicates aortic stenosis; HR, hazard ratio; and PCP, primary care provider.

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  Figure 3. Association of aortic valve replacement with managing provider type for patients with severe aortic stenosis. Plot based on adjusted Cumulative Incidence Function and HR based on cause‐specific hazard model. Covariates include age, sex, White race, region, payor, 28 Elixhauser comorbidity indicators, symptomatic indicator, and year of severe aortic stenosis diagnosis. The colored shading around each curve represents the 95% CI. AVR indicates aortic valve replacement; HR, hazard ratio; and PCP, primary care provider.

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  Figure 4. Association of mortality with managing provider type for patients with severe aortic stenosis. Plot based on adjusted cumulative hazard risk and HR from multivariable Cox proportional hazard model. Covariates include age, sex, White race, region, payor, 28 Elixhauser comorbidity indicators, symptomatic indicator, and year of severe aortic stenosis diagnosis. The colored shading around each curve represents the 95% CI. HR indicates hazard ratio; and PCP, primary care provider.