Abstract 17201: Referral Patterns and Clinical Outcomes in Patients With Severe Aortic Stenosis

Abstract

Introduction: Once aortic stenosis (AS) becomes severe, close clinical follow-up by cardiac specialists and timely aortic valve replacement (AVR) are necessary to optimize patient outcomes. Discrepancies exist in the care of AS. Hypothesis: Provider specialty impacts referral for AVR after an initial echocardiogram (echo) revealing severe AS, with greater referral by cardiac specialists vs. non-cardiologists. Methods: Patients were identified based on an echo finding of new severe AS from Jan 2019 to Dec 2022 in an academic health system and were compared based on the ordering provider’s specialty (cardiology or cardiac surgery specialist vs. non-cardiologist). The primary endpoint was the rate of AVR after the initial echo. Univariable and multivariable logistic regression were used to identify characteristics associated with referral for AVR. Results: The study cohort included 2,131 patients: 630 (30%) were referred to echo by a non-cardiologist, 992 (46%) by cardiology, and 509 (24%) by cardiac surgery specialists (Table). Patients referred to echo by non-cardiologists were older, more frequently Black, and more symptomatic, with a lower rate of vascular diseases and a higher rate of heart failure and kidney disease. Thirty-four percent of patients referred by non-cardiologists, 62% of patients referred by cardiology and 81% of patients referred by cardiac surgery specialists underwent AVR at a median time of 58, 64 and 24 days after their echocardiogram, respectively (P<0.001). Echo referral by cardiology (OR: 2.76, P<0.001), echo referral by cardiac surgery (OR: 7.50; P<0.001), age (OR: 0.96, P<0.001), Black race (OR: 0.60, P<0.001), presence of >=2 CV risk factors (OR: 1.99, P<0.001), and >=2 comorbidities (OR: 1.54, P=0.001) were independent factors associated with AVR. Conclusion: Provider specialty impacts referral to AVR after an echo with new severe AS despite baseline characteristic adjustment, with higher AVR rates by cardiac specialists.