Treatment by cardiologists with the lowest AVR rates was associated with higher 1-year mortality compared to those with the highest rates (adjusted HR 1.22; 95% CI 1.13-1.33).
Cohort (n=26,438)
Yes
Does the managing cardiologist's rate of AVR treatment impact 1-year mortality in patients with symptomatic severe aortic stenosis?
There is substantial clinician-level variability in the application of guideline-recommended AVR for symptomatic severe aortic stenosis, and treatment by cardiologists with lower AVR rates is associated with increased 1-year mortality.
Hazard Ratio: 1.22 (95% CI 1.13–1.33)
Background Patients with symptomatic severe aortic stenosis (ssAS) have a high mortality risk and compromised quality of life. Surgical/transcatheter aortic valve replacement (AVR) is a Class I recommendation, but it is unclear if this recommendation is uniformly applied. We determined the impact of managing cardiologists on the likelihood of ssAS treatment. Methods and Results Using natural language processing of Optum electronic health records, we identified 26 438 patients with newly diagnosed ssAS (2011-2016). Multilevel, multivariable Fine-Gray competing risk models clustered by cardiologists were used to determine the impact of cardiologists on the likelihood of 1-year AVR treatment. Within 1 year of diagnosis, 35.6% of patients with ssAS received an AVR; however, rates varied widely among managing cardiologists (0%, lowest quartile; 100%, highest quartile median, 29.6%; 25th-75th percentiles, 13.3%-47.0%). The odds of receiving AVR varied >2-fold depending on the cardiologist (median odds ratio for AVR, 2.25; 95% CI, 2.14-2.36). Compared with patients with ssAS of cardiologists with the highest treatment rates, those treated by cardiologists with the lowest AVR rates experienced significantly higher 1-year mortality (lowest quartile, adjusted hazard ratio, 1.22, 95% CI, 1.13-1.33). Conclusions Overall AVR rates for ssAS were low, highlighting a potential challenge for ssAS management in the United States. Cardiologist AVR use varied substantially; patients treated by cardiologists with lower AVR rates had higher mortality rates than those treated by cardiologists with higher AVR rates.
Brennan et al. (Fri,) conducted a cohort in symptomatic severe aortic stenosis (n=26,438). Treatment by cardiologists with lowest AVR rates vs. Treatment by cardiologists with highest AVR rates was evaluated on 1-year mortality (adjusted HR 1.22, 95% CI 1.13-1.33). Treatment by cardiologists with the lowest AVR rates was associated with higher 1-year mortality compared to those with the highest rates (adjusted HR 1.22; 95% CI 1.13-1.33).
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