| Autor: |
Thourani, Vinod H., Brennan, J. Matthew, Edelman, J. James, Chen, Qinyu, Boero, Isabel J., Sarkar, Reith R., Murphy, Shannon M. E., Leon, Martin B., Kodali, Susheel K. |
| Zdroj: |
Structural Heart; November 2021, Vol. 5 Issue: 6 p608-618, 11p |
| Abstrakt: |
ABSTRACTBackgroundSymptomatic severe aortic regurgitation (ssAR) is a Class I recommendation for surgical aortic valve replacement (SAVR). We sought to evaluate the practice patterns and drivers of ssAR patients receiving SAVR treatment.MethodsUsing a US dataset of de-identified electronic health records, we identified integrated delivery network patients diagnosed with ssAR between 2008 and 2016 with ≥2 symptom-related notes (heart failure, angina, dyspnea, pre-syncope, or syncope) within six months prior to diagnosis.ResultsFrom a final cohort of 4,608 ssAR patients, 25.7% of ssAR patients underwent SAVR within 1 year of diagnosis; mortality at 1 year was 9% after SAVR, and 24% for those untreated. Using multilevel, multivariable, cause-specific models, women and patients >80 years old were found to be treated significantly less likely [hazard ratios (HR) 0.79 (95% confidence interval [CI]: 0.69–0.90) and 0.28 (0.22–0.37), respectively]. Patients with concomitant moderate/severe aortic stenosis [1.70 (1.43–2.03)], bicuspid aortic valve disease [1.33 (1.13–1.56)], and endocarditis [2.70 (1.04–3.57)] were more likely to be treated. Using multivariable Cox proportional hazard models, ssAR patients managed by cardiologists in the highest SAVR treatment rate tertile had a 23% lower risk of 1-year mortality compared to patients managed by cardiologists in the lowest SAVR treatment rate tertile [0.77 (0.60–0.98)].ConclusionsWe identified significant disparities in the treatment of ssAR patients, specifically women, older patients, and patients managed by cardiologists with a lower SAVR treatment rate. These gaps should be addressed to level the quality of care delivered to all ssAR patients. |
| Databáze: |
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