Mortality Burden of Untreated Aortic Stenosis

Highlights

This study analyzed more than 1.6 million echocardiographic reports and found increasing mortality rates as well as increasing severity of untreated aortic stenosis (AS).
The 4-year untreated all-cause mortality rate ranged from 13.5% in patients without AD to 44.9% in those with severe AD. Despite high mortality rates, the treatment rate of severe AD was relatively low (60.7%).
These findings highlight a critical gap in the treatment of AD, particularly in severe cases.
The low treatment rates of AS emphasize the need for better diagnosis and timely intervention and suggest that more efforts are needed to overcome barriers to adequate care and ensure appropriate aortic valve replacement, ultimately reducing mortality rates among patients with AD.

Background

The American College of Cardiology/American Heart Association guidelines recommend evaluation and classification of the severity of aortic stenosis (AS) as mild, moderate, or severe , by echocardiogram, and recommend aortic valve replacement (AVR) when AD is serious .

Goals

The authors sought to describe mortality rates across the spectrum of untreated aortic stenosis (AS) from a large contemporary real-world database.

Methods

We analyzed a real-world de-identified data set including 1,669,536 echocardiographic reports (1,085,850 patients) from 24 US hospitals (eginte Database, egnite). Patients older than 18 years were classified according to the severity of the AD diagnosis.

Mortality and treatment-untreated rates were examined with Kaplan-Meier (KM) estimates, and results were compared using the log-rank test. Multivariate risk analysis was performed to evaluate associations with all-cause mortality.

Results

Among 595,120 patients with available AD severity assessment, the 4-year Kaplan-Meier (KM)-estimated, unadjusted, untreated, all-cause mortality associated with an AD diagnosis of none, mild, mild to moderate, moderate, moderate to severe or severe was 13.5% (95% CI: 13.3%-13.7%), 25.0% (95% CI: 23.8%-26.1%), 29. 7% (95% CI: 26.8%-32.5%), 33.5% (95% CI: 31.0%-35.8%), 45.7% (95% CI: 37.4 %-52.8%) and 44.9% (95% CI: 39.9%-49.6%), respectively.

The results were similar when adjusted for informational censoring caused by the treatment.

Observed 4-year treatment rates estimated by Kaplan-Meier (KM) were 0.2% (95% CI: 0.2%-0.2%), 1.0% (95% CI: 0.7% -1.3%), 4.2% (95% CI: 2.0%-6.3%), 11.4% (95% CI: 9.5%-13.3%), 36.7 % (95% CI: 31.8%-41.2%) and 60.7% (95% CI: 58.0%-63.3%), respectively. After adjustment, all AD severity grades were associated with increased mortality.

Conclusions

Patients with aortic stenosis (AS) have a high risk of mortality at all levels of untreated AS severity . Aortic valve replacement rates remain low for patients with severe AS, suggesting that more research is needed to understand barriers to diagnosis and the appropriate approach and timing for aortic valve replacement.

Mortality Burden of Untreated Aortic Stenosis

Low rates of treatment for aortic stenosis underscore the urgent need for improved diagnosis and timely intervention to mitigate mortality risks associated with the condition.