AHA still working to find more patients with severe aortic stenosis who may require care
The American Heart Association (AHA) has expanded its Target: Aortic Stenosis quality improvement initiative to ensure that more patients receive timely and appropriate treatment for severe aortic stenosis (AS). Data have shown that a large percentage of patients who receive an echocardiogram and have severe AS are never referred for surgery or transcatheter aortic valve replacement (TAVR).
"We were missing a whole lot of patients. There was data coming out showing that upwards of 50% or more of patients with severe symptomatic AS, where the guidelines are very clear about them needing a valve replacement, were not getting a valve replacement. What happens upstream of the procedure hasn't been examined and the whole reason for this initiative has been to address that huge problem that has a mortality cost and a quality-of-life cost, as many people who warrant treatment are not getting it," explained Brian R. Lindman, MD, MSCI, medical director of the Structural Heart and Valve Center and associate professor of medicine at Vanderbilt University Medical Center, in a new video interview.
Despite clear clinical guidelines, data suggest that more than half of patients with severe symptomatic aortic stenosis do not receive necessary valve replacement. This initiative aims to uncover systemic barriers preventing timely referrals, whether due to incomplete echo reporting, misdiagnosis or the lack of structured referral pathways.
Addressing missed AS referrals
The initiative began in 2019 as an AHA initiative, supported by Edwards Lifesciences. The initial pilot phase included 15 centers, focusing on refining case report forms, establishing key metrics and assessing barriers to treatment.
With additional funding from Edwards in 2022, the program entered its second phase, aiming to expand to 80 centers by the end of 2025. Currently, about 60 centers are participating, with ongoing efforts to involve more hospitals and clinics across the country to reach 80 sites.
Critical metrics for improvement for AS treatment
Lindman said there are two primary metrics the initiative aims to address:
• Timely Diagnosis – Ensuring that patients with echocardiograms suggestive of severe AS receive a definitive diagnosis within 30 days.
• Timely Treatment – Patients with a confirmed class I indication for aortic valve replacement should receive transcatheter or surgical intervention within 90 days.
He said the initiative is also focused on promoting multidisciplinary evaluations, ensuring appropriate echocardiographic follow-ups and improving the completeness of echocardiogram reports.
Closing the treatment gap
Lindman emphasized that the challenge is not just about education; health systems must also think about implementing systems-based solutions to track and improve patient management. The Target: Aortic Stenosis program provides participating sites with dashboards to identify gaps in patient care.
The introduction of TAVR in the past decade has broadened treatment options, making it possible to treat more patients, including those previously considered ineligible for surgery. However, Lindman said many patients with severe AS still fail to receive timely intervention due to systemic inefficiencies. The data generated from this program is designed to show where theses gaps are so that they can be addressed.
"For some sites, they might be lacking some key information in the echo report, so they can now see that and go problem solve there," Lindman explained. "For other sites, they don't have a clear mechanism to get patients referred to the multidisciplinary heart valve team; they might need to improve that process."
Hospitals and health systems interested in joining the initiative can contact the AHA or visit the Target: Aortic Stenosis website for more information.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com