Advancing Quality in the Evaluation, Surveillance, and Management of Aortic Stenosis: A Report From the AHA Target: AS Registry
Abstract
BACKGROUND: Undertreatment and delayed treatment of aortic stenosis (AS) are common, both of which are associated with increased mortality. Historically, assessment of quality for AS care has focused on peri- and postprocedural outcomes. The American Heart Association Target: AS registry is the first national registry to provide data and evaluate quality for upstream processes of care for patients with AS. METHODS: Randomly selected patients from 2023 and 2024 with moderate or severe AS from 58 sites in the Target: AS registry were included. The 2 primary quality measures were (1) timely diagnosis (percentage of patients with an echocardiogram consistent with possible severe AS who had all assessments to clarify AS severity and symptoms within 30 days) and (2) timely treatment (percentage of patients with a Class I indication for aortic valve replacement treated within 90 days). Secondary measures included documentation of key echocardiographic parameters in the report, clinical recommendations in the echocardiogram report summary, multidisciplinary heart valve team evaluation, guideline-based performance of multimodality testing, and timely surveillance echocardiograms. RESULTS: Among 8097 patients, 47% were women, 7% Black, 6% Hispanic, and 3% Asian. Timely diagnosis occurred in 54% in 2023, improving to 61% in 2024 ( P =0.027) with gaps caused by lack of timely symptom assessment (23% [2023]; 16% [2024]), lack of stroke volume index (35% [2023]; 18% [2024]), or lack of timely multimodality testing (87% [2023]; 75% [2024]). Among those with a Class I indication for aortic valve replacement, timely treatment occurred in 82% (2023) versus 85% (2024) ( P =NS). Multidisciplinary heart valve team evaluation occurred in 78% (2023) versus 84% (2024) ( P =0.008). Key findings in the echocardiography report were documented in 83% (2023) and 85% (2024) ( P =NS), but a clinical recommendation was included in <10% of the time. Timely surveillance echocardiograms for moderate (2 years) and severe AS (1 year) were not performed in ~40% of patients. CONCLUSIONS: The national American Heart Association Target: AS registry demonstrates opportunities for improvement in timely diagnosis, surveillance, and treatment for patients with AS at participating centers. By providing an infrastructure to measure performance and identify best practices, the Target: AS registry has the potential to elevate and optimize care and patient outcomes.
Article Details
Authors (20)
Brian R. Lindman
From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) — all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul’s Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) — all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars–Sinai Medical Center, Los Angeles (R.R.M.), and Edwards ...
Linda D. Gillam
Department of Cardiovascular Medicine, Atlantic Health Morristown Medical Center, NJ (L.D.G.).
Elizabeth M. Perpetua
Department of Biobehavioral Health and Informatics, University of Washington School of Nursing, Seattle (E.M.P.).
Sammy Elmariah
Catherine M. Otto
Division of Cardiology, University of Washington School of Medicine, Seattle (C.M.O.).
Marielle Scherrer-Crosbie
Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia (M.S.-C.).
Patrick T. O’Gara
Heart and Vascular Institute, Mass General Brigham, Boston
Martin B. Leon
Cardiovascular Research Foundation, New York
Michael Mack
From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) — all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul’s Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) — all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars–Sinai Medical Center, Los Angeles (R.R.M.), and Edwards ...
Vinod Thourani
Department of Cardiovascular Surgery, Marcus Heart Valve Center, Piedmont Health, Atlanta, GA (V. Thourani).
Ty J. Gluckman
Center for Cardiovascular Analytics, Research, and Data Science, Providence Heart Institute, Providence St. Joseph Health, Portland, OR (T.J.G.).
Harold L. Dauerman
Division of Cardiology, University of Vermont, Burlington (H.L.D.).
Varsha Tanguturi
Heart and Vascular Institute, MassGeneral Brigham, Boston (P.T.O., V. Tanguturi).
Olcay Aksoy
Division of Cardiology, University of California-Los Angeles, Ronald Reagan–University of California-Los Angeles Medical Center (O.A., G.C.F.).
Sara O’Kane
Department of Quality, Outcomes Research, and Analytics (S.O., D.L.), American Heart Association, Dallas, TX.
Daniel Linn
Department of Quality, Outcomes Research, and Analytics (S.O., D.L.), American Heart Association, Dallas, TX.
Mariell Jessup
Chief Science Officer (M.J.), American Heart Association, Dallas, TX.
Gregg C. Fonarow
Clyde W. Yancy
From the Department of Medicine, Northwestern Memorial Hospital, Chicago (C.W.Y.); and the Departments of Medicine (J.S.G., A.J.Y.), Radiology (B.G.G.), and Pathology (B.M.H.), Massachusetts General Hospital, the Departments of Medicine (J.S.G., R.H.F., A.J.Y.), Radiology (B.G.G.), and Pathology (B.M.H.), Harvard Medical School, and the Department of Medicine, Brigham and Women’s Hospital (R.H.F.) — all in Boston.
Sreekanth Vemulapalli
Division of Cardiology, Duke University School of Medicine, Durham, NC (S.V.).