Early cardiologist follow-up determines treatment rates and survival among aortic stenosis patients

• Published in: European heart journal Vol. 44; no. Supplement_2
• Main Authors: Rapp, O, Shimoni, O, Klempner, R, Segev, A, Pounds, C, Massalha, E
• Format: Journal Article
• Language: English
• Published: 09.11.2023
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehad655.3019

Abstract Background Aortic valve replacement (AVR) has been constant as it is considered an effective disease-modifying procedure for patients with severe aortic stenosis (sAS). However, the implanter is only one part of it. Patients with sAS generally require ongoing care and support from a multidisciplinary team that includes general cardiologists (GC) and other primary care providers, who guide and manage the patient through the therapeutic process. Purpose The current study aims to assess the impact of a cardiologist or other primary care provider managing the therapeutic process in the early period first phase following the sAS diagnosis. Methods A large-scale database of Maccabi Health Services, the second largest health maintenance organization (HMO) in Israel, counting Israel with nearly 2.8 million members, was retrospectively analyzed from 2005 to 2021 for all patients over 60 years, with detailed echocardiography compatible with a diagnosis of sAS. The database was extracted using the MDClone healthcare data platform, generating the synthetic cohort database reliably representing the original population. sAS patients managed by GC versus non-GC care providers were assessed for differences in AVR rates, and all-cause mortality was assessed in sAS patients managed by GC versus non-GC care providers. Results A total of 1570 sAS patients were included in the final analysis. Of them, GCs managed GC managed 65% in the early phase (3 months) following the sAS diagnosis. sAS with heart failure (21% vs. 17%) and atrial fibrillation (26% vs. 19%) were less likely managed by GC. No statistically significant differences were observed in other baseline characteristics, including age, gender, and comorbidities. A propensity score matching analysis revealed a significant difference in 12-month and 24-month AVR rates following diagnosis between the GC versus non-GG groups (19% vs. 3%, and 28% vs. 9%, respectively. P<0.01 for both). sAS patients managed by a GC show a significant survival benefit, 31% vs. 36% within five years after diagnosis P < 0.05. Conclusions Patients with sAS managed by a GC within three months after diagnosis had significantly higher chances for AVR and, consequently, better prognosis. These findings emphasize the importance of GC management in sAS.