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A Review of "Access to Care" Issues in Aortic Stenosis Patients: A Negative Report Card
Adam M Reisman1, Sammy Elmariah2
1Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York.
Insights
Many patients with aortic stenosis are undiagnosed or undertreated, especially women and minorities. Early referral to heart valve specialists is crucial for timely aortic valve replacement and improved patient outcomes.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Valvular Heart Disease
Background:
- Aortic stenosis (AS) management involves a continuum from health to post-treatment recovery.
- Significant care gaps exist, leading to underdiagnosis and undertreatment of AS.
- Disparities in AS care are noted among underrepresented minority groups and women.
Purpose of the Study:
- To highlight barriers in the identification and management of aortic stenosis.
- To emphasize the need for improved diagnosis and treatment strategies for AS.
- To underscore the importance of timely referral for aortic valve replacement.
Main Methods:
- Review of the continuum of care for aortic stenosis patients.
- Analysis of diagnostic and treatment rates for symptomatic severe AS.
- Examination of treatment disparities in specific patient populations.
Main Results:
- Many patients with AS are not clinically recognized despite diagnostic echocardiograms.
- Less than 50% of symptomatic severe AS patients undergo aortic valve replacement within two years.
- Treatment rates are lower for symptomatic low-gradient severe AS.
- Underrepresented minorities and women experience higher rates of mismanagement.
Conclusions:
- Timely referral to a heart valve team specialist is essential for aortic valve replacement consideration.
- Expert consultation facilitates shared decision-making and access to life-saving interventions.
- Addressing care gaps is critical to optimize outcomes for all patients with aortic stenosis.
Abstract:
The identification and management of patients with aortic stenosis exist along a continuum that includes healthy living, latent progression, diagnosis, treatment, and posttreatment recovery. Barriers to the provision of appropriate care for these patients can occur at any stage along this continuum. Despite the presence of diagnostic echocardiograms, many patients with aortic stenosis are never clinically recognized, and the rate of mismanagement worsens among underrepresented minority groups and women. Regarding the treatment of clinically recognized aortic stenosis, only about half of patients with symptomatic severe aortic stenosis actually undergo aortic valve replacement within 2 years of diagnosis. Treatment rates are even lower among patients with symptomatic low-gradient severe aortic stenosis. Although several strategies have been raised by experts within the field to help and improve the diagnosis and treatment of patients with aortic valve disease, timely referral to a heart valve team specialist whenever aortic valve replacement is being considered likely remains the most pertinent intervention. Connecting these patients with fully informed aortic valve disease experts helps facilitate shared decision-making discussions, thus ensuring that patients have the opportunity to learn about and potentially receive the lifesaving interventions available to them.
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