TEMPORAL TRENDS AND DETERMINANTS OF AORTIC VALVE REPLACEMENT IN PATIENTS WITH ASYMPTOMATIC SEVERE AORTIC STENOSIS
Author(s)
Duy Hoang, PhD1, Mary Imboden, PhD2, Xiaofan Liu, MPH3, Rebecca A. Horn, PhD4, Hui Wang, PhD5, Zheng Zeng, PhD6, Yang Yu, PhD7, Nina B. Masters, PhD1, Karen Gilbert Farrar, PhD1, Angela Lowe Winegar, PhD8, Brianna Cartwright, MS1, Ty J. Gluckman, MD2.
1Truveta, Bellevue, WA, USA, 2Providence, Portland, OR, USA, 3University of Southern California, Los Angeles, CA, USA, 4Edwards Lifesciences, Wichita, KS, USA, 5Lumbrita LLC, Saratoga, CA, USA, 6Lumbrita, San Francisco, CA, USA, 7Abbott, Santa Clara, CA, USA, 8Ascension, Austin, TX, USA.
1Truveta, Bellevue, WA, USA, 2Providence, Portland, OR, USA, 3University of Southern California, Los Angeles, CA, USA, 4Edwards Lifesciences, Wichita, KS, USA, 5Lumbrita LLC, Saratoga, CA, USA, 6Lumbrita, San Francisco, CA, USA, 7Abbott, Santa Clara, CA, USA, 8Ascension, Austin, TX, USA.
OBJECTIVES: Aortic valve replacement (AVR) is strongly recommended for symptomatic severe aortic stenosis (SAS). Additional support for AVR among patients with asymptomatic SAS became available in October 2024 following publication of the EARLY TAVR trial. Accordingly, we quantified 6-month receipt of AVR (transcatheter [TAVR] or surgical [SAVR]) among patients with asymptomatic SAS before the EARLY TAVR study and factors associated with these procedures.
METHODS: In this retrospective cohort study, echocardiographic data from Truveta, a collective of US healthcare systems, was used to identify patients with SAS in 2017-2024. Symptom status was extracted from electronic health records. Patients were segmented based on their aortic valve gradient and left ventricular ejection fraction (EF), including high gradient-normal EF (HG‑NEF) and low gradient-normal-EF (LG‑NEF). The primary outcome was AVR within six months of the index echocardiogram. Fine-Gray competing‑risk models estimated a subdistribution hazard ratio (sHR), adjusting for sociodemographic characteristics and comorbidities. Censoring occurred at the procedure, last encounter, development of symptoms, or at six months.
RESULTS: The study identified 19,441 asymptomatic patients with SAS. Rates of AVR increased from 4.7% in 2017 to 24.6% in 2024, with increases for both TAVR (2.5% to 16.0%) and SAVR (2.2% to 8.6%). Compared with LG‑NEF, HG‑NEF had higher sHRs for any AVR (sHR 2.07; 95% CI 1.90-2.25), TAVR (2.17; 1.97-2.38), and SAVR (1.66; 1.37-2.00). Drivers of TAVR over this period included older ages 75-84 (vs. 50-64) (sHR 3.52; 95% CI 2.88-4.32), male sex (1.3; 1.19-1.41), White race (1.69; 1.15-2.56), urbanicity (1.11; 1.01-1.23), and Elixhauser comorbidity ≥5 (vs. none) (2.24; 1.69-2.98).
CONCLUSIONS: Among asymptomatic patients with SAS, rates of AVR increased substantially in the years that predated the EARLY TAVR trial. Heterogeneity in AVR was observed based on aortic valve gradient, left ventricular EF, sociodemographic characteristics, and comorbidities.
METHODS: In this retrospective cohort study, echocardiographic data from Truveta, a collective of US healthcare systems, was used to identify patients with SAS in 2017-2024. Symptom status was extracted from electronic health records. Patients were segmented based on their aortic valve gradient and left ventricular ejection fraction (EF), including high gradient-normal EF (HG‑NEF) and low gradient-normal-EF (LG‑NEF). The primary outcome was AVR within six months of the index echocardiogram. Fine-Gray competing‑risk models estimated a subdistribution hazard ratio (sHR), adjusting for sociodemographic characteristics and comorbidities. Censoring occurred at the procedure, last encounter, development of symptoms, or at six months.
RESULTS: The study identified 19,441 asymptomatic patients with SAS. Rates of AVR increased from 4.7% in 2017 to 24.6% in 2024, with increases for both TAVR (2.5% to 16.0%) and SAVR (2.2% to 8.6%). Compared with LG‑NEF, HG‑NEF had higher sHRs for any AVR (sHR 2.07; 95% CI 1.90-2.25), TAVR (2.17; 1.97-2.38), and SAVR (1.66; 1.37-2.00). Drivers of TAVR over this period included older ages 75-84 (vs. 50-64) (sHR 3.52; 95% CI 2.88-4.32), male sex (1.3; 1.19-1.41), White race (1.69; 1.15-2.56), urbanicity (1.11; 1.01-1.23), and Elixhauser comorbidity ≥5 (vs. none) (2.24; 1.69-2.98).
CONCLUSIONS: Among asymptomatic patients with SAS, rates of AVR increased substantially in the years that predated the EARLY TAVR trial. Heterogeneity in AVR was observed based on aortic valve gradient, left ventricular EF, sociodemographic characteristics, and comorbidities.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH183
Topic
Epidemiology & Public Health
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)