Echocardiographic Surveillance Patterns in Patients With Aortic Stenosis: Suboptimal Application of Clinical Practice Guidelines.

Abstract

We aimed to describe the likelihood of guideline-directed TTE surveillance and factors impacting follow-up of patients with aortic sclerosis (AScl) and AS. We analyzed our institution's Echocardiography Laboratory database (2005-2022) to identify Olmsted County residents with AScl or AS. Cases were classified into 4 groups: AScl, mild AS, moderate AS, severe AS. The primary composite outcome was follow-up TTE within guideline-recommended intervals or death. We included 21,496 TTEs in 9,401 patients, of which 4,712 (50.1%) were women. At first TTE, there were 7,149 (76.0%) patients with AScl, 1,470 (15.6%) with mild AS, 471 (5.0%) with moderate AS, and 311 (3.3%) with severe AS. We noted that 30% (95% confidence interval [CI] 27-33%) of TTEs showing severe AS were unmonitored (no follow-up TTE or death) at 1 year, 21% (95% CI 19-24%) of TTEs showing moderate AS were unmonitored at 2 years, 10% (95% CI 9.3-12%) of TTEs showing mild AS were unmonitored at 5 years, and 22% (95% CI 21-23%) of TTEs showing AScl were unmonitored at 5 years. TTEs performed on women were more likely to be unmonitored, regardless of AS severity or age. Most studies (67.9%) were ordered by non-cardiology specialties; surveillance imaging from these providers was less likely to adhere to guideline-recommended intervals than studies ordered by cardiology providers. We identified significant gaps in guideline adherence for TTE surveillance in AS regardless of severity (Graphical Abstract).