Association Between Patient Survival and Clinician Variability in Treatment Rates for Aortic Valve Stenosis

Area of Science:

• Cardiology
• Health Services Research
• Medical Informatics

Background:

• Symptomatic severe aortic stenosis (ssAS) presents significant mortality risk and reduced quality of life.
• Aortic valve replacement (AVR) is a Class I recommendation for ssAS, yet its uniform application is uncertain.

Purpose of the Study:

• To investigate the influence of managing cardiologists on the likelihood of ssAS treatment with AVR.
• To assess the impact of cardiologist-driven AVR utilization on patient outcomes.

Main Methods:

• Natural language processing of 26,438 patients with newly diagnosed ssAS from Optum electronic health records (2011-2016).
• Multilevel, multivariable Fine-Gray competing risk models clustered by cardiologist to evaluate 1-year AVR treatment likelihood.
• Analysis of treatment rate variations and associated 1-year mortality.

Main Results:

• Only 35.6% of ssAS patients received AVR within one year, with significant variation among cardiologists (0% to 100%).
• Cardiologist odds ratio for AVR varied more than twofold (median OR, 2.25).
• Patients treated by cardiologists with lower AVR rates had significantly higher 1-year mortality (aHR, 1.22).

Conclusions:

• Overall AVR rates for ssAS remain low in the US, posing a management challenge.
• Substantial variation exists in cardiologist AVR utilization for ssAS.
• Lower AVR rates by cardiologists correlate with increased patient mortality, underscoring the need for standardized treatment protocols.