Valvular & structural heart disease
Examining lack of referrals to heart valve specialists as mechanisms of potential underutilization of aortic valve replacement
Authors' conclusion
A substantial proportion of severe AS patients meeting indications for AVR are not evaluated by HVS and experience markedly increased mortality.
Study context
- Population
- Patients with severe aortic stenosis (AS) meeting class I indication for intervention, 2015–2018
- Participants
- 981 patients
- Exposure
- Assessed by heart valve specialists vs not assessed
- Heart valve specialists (HVS)n = 790
- Outcome
- Assessment by HVS within six months of index TTE
- Follow-up
- Six months
Main finding
As reported in the abstract
- Assessed by HVS
- 790 (80.5%)
- Increasing age, reduced referral: OR 0.95 (95% CI 0.94-0.97)
- P < .001
- Unmarried status, reduced referral: OR 0.59 (95% CI 0.43-0.83)
- P = .002
- Inpatient TTE, reduced referral: OR 0.27 (95% CI 0.19-0.38)
- P < .001
- Higher hematocrit, increased referral: OR 1.13 (95% CI 1.09-1.16)
- P < .001
- Higher eGFR, increased referral: OR 1.01 (95% CI 1.00-1.02)
- P = .003
- Mean aortic valve gradient, increased referral: OR 1.03 (95% CI 1.01-1.04)
- P < .001
- Preserved LVEF, increased referral: OR 1.59 (95% CI 1.02-2.48)
- P = .04
Observational data: associations, not effects.
Further findings
| Outcome | aHR (95% CI) | P value | |
|---|---|---|---|
| Two-year mortality · two yearsHVS referral as a time-dependent covariate | 0.30 (0.23–0.39) | P < 0.001 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
Original publication
Examining lack of referrals to heart valve specialists as mechanisms of potential underutilization of aortic valve replacement. Am Heart J. Published 15 April 2024. doi:10.
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