June 26, 2026Circulation
Advancing Quality in the Evaluation, Surveillance, and Management of Aortic Stenosis: A Report From the AHA Target: AS Registry
Brian R. LindmanLinda D. GillamElizabeth M. PerpetuaSammy ElmariahCatherine M OttoMarielle Scherrer‐CrosbiePatrick T. O’GaraMartin B. LeonMichael J. MackVinod ThouraniTy J. GluckmanHarold L. DauermanVarsha TanguturiOlcay AksoySara O’KaneDaniel LinnMariell JessupGregg C. FonarowClyde W. YancySreekanth Vemulapalli
Why the study?
Undertreatment and delayed treatment of aortic stenosis (AS) are common and increase mortality, while quality assessment historically focused on peri- and postprocedural outcomes rather than upstream care.
Key Points
- To evaluate quality measures for the evaluation and management of aortic stenosis (AS) using the AHA Target: AS registry.
- Randomly selected patients from 58 sites in the Target: AS registry for 2023-2024
- Evaluated timely diagnosis and treatment for moderate or severe AS
- Analyzed secondary measures including clinical recommendations and surveillance echocardiograms.
- Timely diagnosis improved from 54% in 2023 to 61% in 2024 (P=0.027)
- Timely treatment increased from 82% (2023) to 85% (2024) (P=NS)
- Multidisciplinary evaluations rose from 78% (2023) to 84% (2024) (P=0.008).
Study Design
Type
Observational (n=8,097)
Multicenter
Yes
Structured PICO
P
Population
8,097 patients with moderate or severe aortic stenosis from 58 sites in the US Target: AS registry, evaluated for quality of care metrics in 2023 and 2024.
O
Outcome
1) Timely diagnosis (percentage of patients with an echocardiogram consistent with possible severe AS who had all assessments to clarify AS severity and symptoms within 30 days) and 2) timely treatment (percentage of patients with a Class I indication for aortic valve replacement treated within 90 days)
Main Result
Absolute Event Rate: 61% vs 54%
p-value: p=0.027
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“With respect to several other quality measures, there were significant gaps in care that were identified through these registry metrics. As we move forward to address additional gaps in care, there are several tools that are already being implemented and there will be more in the years to come.”
“We were missing a whole lot of patients. There was data coming out showing that upwards of 50% or more of patients with severe symptomatic AS, where the guidelines are very clear about them needing a valve replacement, were not getting a valve replacement. What happens upstream of the procedure hasn't been examined and the whole reason for this initiative has been to address that huge problem that has a mortality cost and a quality-of-life cost, as many people who warrant treatment are not getting it.”
“Even after echocardiography is done to identify significant VHD, sometimes the echocardiogram alone is not sufficient to clarify the severity of VHD. Often the additional testing needed to clarify severity is not done promptly, yielding a delay in recognition/diagnosis of severe VHD. The quality measures provide accountability to help ensure that the additional testing and assessments needed to clarify the severity of VHD and whether treatment is warranted is done promptly, thereby ensuring accurate timely diagnosis.”
Implication
Modest gains in timely AS diagnosis and team evaluation support quality initiatives; leaves open impact on outcomes and treatment rates.
Abstract
BACKGROUND: Undertreatment and delayed treatment of aortic stenosis (AS) are common, both of which are associated with increased mortality. Historically, assessment of quality for AS care has focused on peri- and postprocedural outcomes. The American Heart Association Target: AS registry is the first national registry to provide data and evaluate quality for upstream processes of care for patients with AS. METHODS: Randomly selected patients from 2023 and 2024 with moderate or severe AS from 58 sites in the Target: AS registry were included. The 2 primary quality measures were (1) timely diagnosis (percentage of patients with an echocardiogram consistent with possible severe AS who had all assessments to clarify AS severity and symptoms within 30 days) and (2) timely treatment (percentage of patients with a Class I indication for aortic valve replacement treated within 90 days). Secondary measures included documentation of key echocardiographic parameters in the report, clinical recommendations in the echocardiogram report summary, multidisciplinary heart valve team evaluation, guideline-based performance of multimodality testing, and timely surveillance echocardiograms. RESULTS: Among 8097 patients, 47% were women, 7% Black, 6% Hispanic, and 3% Asian. Timely diagnosis occurred in 54% in 2023, improving to 61% in 2024 ( P =0.027) with gaps caused by lack of timely symptom assessment (23% [2023]; 16% [2024]), lack of stroke volume index (35% [2023]; 18% [2024]), or lack of timely multimodality testing (87% [2023]; 75% [2024]). Among those with a Class I indication for aortic valve replacement, timely treatment occurred in 82% (2023) versus 85% (2024) ( P =NS). Multidisciplinary heart valve team evaluation occurred in 78% (2023) versus 84% (2024) ( P =0.008). Key findings in the echocardiography report were documented in 83% (2023) and 85% (2024) ( P =NS), but a clinical recommendation was included in <10% of the time. Timely surveillance echocardiograms for moderate (2 years) and severe AS (1 year) were not performed in ~40% of patients. CONCLUSIONS: The national American Heart Association Target: AS registry demonstrates opportunities for improvement in timely diagnosis, surveillance, and treatment for patients with AS at participating centers. By providing an infrastructure to measure performance and identify best practices, the Target: AS registry has the potential to elevate and optimize care and patient outcomes.
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Cite This Study
Lindman et al. (2026) conducted an observational in Moderate or severe aortic stenosis (n=8,097). Year 2024 vs. Year 2023 was evaluated on Timely diagnosis (percentage of patients with an echocardiogram consistent with possible severe AS who had all assessments to clarify AS severity and symptoms within 30 days) (p=0.027).