Valvular & structural heart diseaseCohort study
Association of Guideline-Concordant Echocardiographic Surveillance With Mortality and Aortic Valve Replacement in US Adults With Aortic Stenosis
- Retrospective cohort
- validated natural language processing algorithms applied to echocardiogram reports
- multivariable Cox proportional hazards regression
Authors' conclusion
Implementation of the current American College of Cardiology/American Heart Association guideline-recommended echocardiographic surveillance frequency in adults with AS is associated with improved outcomes yet remains suboptimal in real-world settings.
Study context
- Population
- Patients with aortic stenosis at Kaiser Permanente Northern California, January 1, 2008, to September 30, 2017; patients with prior aortic valve replacement (AVR) excludedpatients with aortic stenosis (AS)
- Participants
- 20,571 patients
- Exposure
- associations between guideline concordance and all-cause death and receipt of AVR
Main finding
As reported in the abstract
Deaths and AVRs · median follow-up of 5.2 (interquartile range, 3.0-7.4) years
| Group | deaths | AVRs |
|---|---|---|
| Guideline concordant | 1929 (28.8%) | 1783 (26.6%) |
| Not concordant | 3683 (42.2%) | 1266 (14.5%) |
Observational data: associations, not effects.
Further findings
Adjusted all-cause death, by AS severity
| Comparison | aHR | |
|---|---|---|
| Guideline concordant · moderate AS | 0.76 (95% CI 0.68–0.85) | |
| Guideline concordant · moderate-to-severe AS | 0.70 (CI 0.54–0.91) | |
| Guideline concordant · severe AS | 0.62 (CI 0.51–0.76) | |
| 0.512Adjusted hazard ratio (log scale) |
AVR, by AS severity
| Comparison | aHR (CI) | |
|---|---|---|
| Guideline concordant · mild AS | 2.23 (1.93–2.57) | |
| Guideline concordant · mild-to-moderate AS | 1.56 (1.22–1.99) | |
| Guideline concordant · moderate AS | 1.45 (1.28–1.64) | |
| Guideline concordant · moderate-to-severe AS | 2.09 (1.62–2.69) | |
| Guideline concordant · severe AS | 1.95 (1.60–2.36) | |
| 0.20.5125Adjusted hazard ratio (log scale) |
- Adjusted all-cause death, by AS severity: lower adjusted all-cause death with guideline concordance for those with at least moderate AS
- AVR, by AS severity: higher rates of AVR with guideline concordance across all AS severity levels
Rates of guideline concordance
- mild AS
- 74%
- mild-to-moderate AS
- 51%
- moderate AS
- 63%
- moderate-to-severe AS
- 51%
- severe AS
- 49%
Factors associated with guideline concordance
- Male sex, younger age, having a cardiologist, and certain comorbid conditions were positively associated with guideline concordance
Original publication
Association of Guideline-Concordant Echocardiographic Surveillance With Mortality and Aortic Valve Replacement in US Adults With Aortic Stenosis. Circ Popul Health Outcomes. Published 5 March 2026. doi:10.1161/circoutcomes.125.012822
Summarised from the published abstract; every number is checked against it