Severe aortic stenosis (SAS), also known as heart valve failure, can quickly become fatal1
While watchful waiting may be a typical approach to managing patients with SAS, it may lead to poorer outcomes and a higher risk of irreversible cardiac damage.2
As you know, when patients with SAS start to present with symptoms, it's a signal for imminent danger. Every week counts. This reinforces the need for lifesaving aortic valve replacement (AVR)—and that begins by referring your patients to a Heart Valve Team for evaluation sooner.1
Earlier referral can give your patients a greater chance of survival, reduced hospitalization, and prevention of cardiac damage occurrence and progression.2,3
What are some best practices when managing patients with aortic stenosis?
“In the management of symptomatic severe aortic stenosis (sSAS), the absolutely crucial first step is to refer these patients to a Heart Valve Team.”
-
Sammy Elmariah, MD, MPH Interventional Cardiologist and Heart Valve Specialist
1 IN 10 PATIENTS WITH SYMPTOMATIC SEVERE AORTIC STENOSIS (sSAS) CAN DIE WITHIN 5 WEEKS WITHOUT INTERVENTION*1
Their risk of death only increases with time1
in 6 months
in 1 year
in 2 years
*Patients were recommended for and awaiting AVR.
Certain patient populations are disproportionately affected by aortic stenosis (AS) underdiagnosis4-6
Globally, cardiovascular disease is the leading cause of death in women. Yet they are particularly vulnerable to underdiagnosis and undertreatment.4,7
Key differences in pathophysiology and clinical presentation exist between men and women with AS4,7
Women are more prone to paradoxical low-flow, low-gradient AS, which can play a role in delayed diagnosis and referral for AVR7
Women present with more aortic valve fibrosis than calcification and have different processes of cardiac remodeling7
Women have a worse prognosis than men, including increased risk of cardiac events and mortality due to left ventricular hypertrophy8,9
Once diagnosed with heart valve disease, women have a 10% lower likelihood of appropriate transthoracic echocardiographic (TTE) surveillance than men10
Women with sSAS were shown to be 20% less likely than men to receive AVR11
The undertreatment of AS is critical. Outcomes are directly impacted when patients are not referred to a Heart Valve Team sooner for evaluation.12
AS is widely undertreated, and disparities exist across geography, care setting, and provider type.4-6
Even at Centers of Excellence, about 50% of patients with a class I or potential class IIa indication for AVR did not receive treatment13
N=6150, 2000-201713
Nationwide network and data set show that nearly 60% of sSAS patients did not receive treatment14
N=6859, 2011-201614
Across 15 hospitals, almost 50% of sSAS patients were untreated within 90 days post diagnosis according to registry data12
N=1286, 2018-202012
Real world registry for 24 hospitals showed that ~40% of sSAS patients were still untreated up to 4 years post diagnosis15
N=12,129 2016-202215
REFERENCE THE GUIDELINES
If in doubt, the 2020 ACC/AHA Guidelines have the answers.
References:1.Malaisrie SC, McDonald E, Kruse J, et al. Mortality while waiting for aortic valve replacement. Ann Thorac Surg. 2014;98(5):1564-1571.2.Treibel TA, Kozor R, Schofield R, et al. Reverse myocardial remodeling following valve replacement in patients with aortic stenosis. J Am Coll Cardiol. 2018;71(8):860-871. 3.Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143(5):e72-e22.4.Tribouilloy C, Bohbot Y, Rusinaru D, et al. Excess mortality and undertreatment of women with severe aortic stenosis. J Am Heart Assoc. 2021;10(1):e018816.5.Ahmed Y, van Bakel PAJ, Hou H, et al. Racial and ethnic disparities in diagnosis, management and outcomes of aortic stenosis in the Medicare population. PLoS One. 2023;18(4):e0281811.6.Crousillat DR, Amponasah DK, Camacho, et al. Racial and ethnic differences in the clinical diagnosis of aortic stenosis. Am Heart Assoc. 2022;11(24):e025692.7.Mahowald MK, Esmail K, Ezzeddine FM, Choi C, Mieszczanska H, Velarde G. Sex disparities in cardiovascular disease. Methodist Debakey Cardiovasc J. 2024;20(2):107-119.8.Hervault M, Clavel MA. Sex-related differences in calcific aortic valve stenosis: pathophysiology, epidemiology, etiology, diagnosis, presentation, and outcomes. Structural Heart. 2018;2(2)102-113.9.Capoulade R, Clavel MA, Le Ven F, et al. Impact of left ventricular remodelling patterns on outcomes in patients with aortic stenosis. Eur Heart J Cardiovasc Imaging. 2017;18(12):1378-1387.10.Tanguturi VK, Bhambhani V, Picard MH, Armstrong K, Wasfy JH. Echocardiographic surveillance of valvular heart disease in different sociodemographic groups. JACC Cardiovasc Imaging. 2019;12(4):751-752.11.Lowenstern A, Sheridan P, Wang TY, et al. Sex disparities in patients with symptomatic severe aortic stenosis. Am Heart J. 2021;237:116-127.12.Lindman BR, Fonarow GC, Myers G, et al. Target Aortic Stenosis: a national initiative to improve quality of care and outcomes for patients with aortic stenosis. Circ Cardiovasc Qual Outcomes. 2023;16(6): e009712.13.Li SX, Patel NK, Flannery LD, et al. Trends in utilization of aortic valve replacement for severe aortic stenosis. J Am Coll Cardiol. 2022;79(9):864-877.14.Brennan JM, Leon MB, Sheridan P, et al. Racial differences in the use of aortic valve replacement for treatment of symptomatic severe aortic valve stenosis in the transcatheter aortic valve replacement era. J Am Heart Assoc. 2020;9(16):e015879.15.Généreux P, Sharma RP, Cubeddu RJ, et al. The mortality burden of untreated aortic stenosis. J Am Coll Cardiol. 2023;82(22):2101-2109.
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