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September 8, 2026American Heart Journal Plus Cardiology Research and PracticeOpen Access

The impact of underdiagnosis and delay in care for patients with moderate and severe aortic stenosis: A real-world database cohort study

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Why the study?

Despite advances in diagnostic capabilities and therapeutic options for aortic stenosis, evidence suggests substantial underdiagnosis and care delays in real-world practice.

Does formal ICD-coded diagnosis of echocardiographically identified aortic stenosis improve the likelihood of receiving subsequent care?

Population

2366 moderate and 1327 severe aortic stenosis patients with first echocardiographic evidence

Comparison

Formal ICD-coded diagnosis vs no formal diagnosis, stratified by severity, demographics, and care setting

Design

Real-world database cohort study

Follow-up

One year

Key result

Formal ICD-coded diagnosis of aortic stenosis was associated with an increased likelihood of subsequent care in patients with moderate (HR 1.68, P<0.0001) and severe (HR 2.25, P<0.0001) disease.

Authors

BPBen PetersonJSJordan B. StromMRMichael Ryan

Discussion

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Member takes

Overview

Delays in AS diagnosis after echocardiography may impact timely care; leaves open targeted strategies to address disparities.

Study Design

Type

Cohort (n=3,693)

Structured PICO

Does formal ICD-coded diagnosis of echocardiographically identified aortic stenosis improve the likelihood of receiving subsequent care?

P
Population
3,693 patients with first echocardiographic evidence of moderate (n=2,366) or severe (n=1,327) aortic stenosis identified from a real-world database.
E
Exposure
Formal ICD-coded diagnosis of aortic stenosis following echocardiographic identification.
C
Comparator
Lack of formal ICD-coded diagnosis.
O
Outcome
Time to formal diagnosis (ICD code assignment) and subsequent care (composite of follow-up imaging or aortic valve replacement).

Main Result

Hazard Ratio: 1.68

p-value: p=<0.0001

There is a substantial gap between echocardiographic detection and formal ICD-coded diagnosis of aortic stenosis, particularly among women and non-White patients, and formal diagnosis is strongly associated with receiving appropriate subsequent care.

Limitations

  • Administrative claims data alone may substantially underestimate the true burden of AS in the population.

Cite This Study

Peterson et al. (2026) conducted a cohort in Moderate and severe aortic stenosis (n=3,693). Formal ICD-coded AS diagnosis vs. No formal diagnosis was evaluated on Subsequent care (composite of follow-up imaging or aortic valve replacement) (HR 1.68, p=<0.0001). Formal ICD-coded diagnosis of aortic stenosis was associated with an increased likelihood of subsequent care in patients with moderate (HR 1.68, P<0.0001) and severe (HR 2.25, P<0.0001) disease.

synapsesocial.com/papers/6aa92b45d7d677827e25573ahttps://doi.org/10.1016/j.ahjo.2026.100884
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