Abstract 4143931: Guideline Adherence in Severe Aortic Stenosis: Determinants of Timely Aortic Valve Replacement and Echocardiography Follow-up

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Background: According to the 2020 ACC/AHA guidelines, patients with severe aortic stenosis (AS) should either undergo rapid AVR or be followed by an echocardiogram (echo) every 6-12 months to assess disease progression. Discrepancies have been reported in the care of severe AS. Goal: This study aims to evaluate adherence to guidelines, and identify factors associated with guidelines recommended care in patients with severe AS. Methods: All patients with a first echo report of severe AS diagnosis from January 2019 to December 2022 in a tertiary care academic health center were included. Adherence to guidelines was defined as undergoing AVR in 6 months or having a follow-up echo within 6-12 months of the index echo. Univariable and multivariable Cox proportional hazards models were performed to identify factors associated with guidelines recommended care. Patients who did not meet the endpoint and died before one year were censored at the time of death. Results: Of the 1655 patients included in the study (mean ± SD age: 77±12 years, 56% male, 80% white, 10% African-American, and 10% other race), 727 (43%) had AVR in 6 months, 184 (11%) had no AVR in 6 months but a follow-up echo within 6-12 months, and 744 (45%) did not achieve the guidelines recommended care. Two hundred and thirty-eight (14%) patients died within one year (178 patients did not meet guidelines). The multivariable Cox proportional hazards model (Table) revealed that younger age, lower LVEF, higher aortic valve mean gradient, cardiovascular history or risk factors, and having a cardiac specialty provider increased the rate of adherence to guidelines, while African-Americans and patients with renal failure were less likely to receive the guidelines recommended care. Conclusions: A substantial proportion of patients with severe AS does not receive the guidelines recommended care and follow-up. Factors including age, race, comorbidities such as renal failure, cardiovascular history and risk factors, provider specialty, and characteristics of the AS are associated with these discrepancies. These results call for urgent action to guide patient and provider behavior towards equitably implementing guideline-recommended valvular heart disease therapies.

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