TY - JOUR
T1 - Association between patient survival and clinician variability in treatment rates for aortic valve stenosis
AU - Brennan, J. Matthew
AU - Lowenstern, Angela
AU - Sheridan, Paige
AU - Boero, Isabel J.
AU - Thourani, Vinod H.
AU - Vemulapalli, Sreekanth
AU - Wang, Tracy Y.
AU - Liska, Otto
AU - Gander, Stuart
AU - Jager, Jason
AU - Leon, Martin B.
AU - Peterson, Eric D.
N1 - Funding Information:
The authors thank Erin Campbell, MS, for her editorial contributions to this manuscript and Boye Gricar, PhD, Emily Farrar, PhD, and Sibyl Munson, PhD, of Boston Strategic Partners, Inc., for assistance with manuscript preparation. Sources of Funding This study was funded by Edwards Lifesciences, Irvine, CA, which was not involved in the study design, analysis and interpretation of data, or the writ-ing of the report.
Publisher Copyright:
© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2021/8/17
Y1 - 2021/8/17
N2 - BACKGROUND: Patients with symptomatic severe aortic stenosis (ssAS) have a high mortality risk and compromised quality of life. Surgical/transcatheter aortic valve replacement (AVR) is a Class I recommendation, but it is unclear if this recommendation is uniformly applied. We determined the impact of managing cardiologists on the likelihood of ssAS treatment. METHODS AND RESULTS: Using natural language processing of Optum electronic health records, we identified 26 438 patients with newly diagnosed ssAS (2011–2016). Multilevel, multivariable Fine-Gray competing risk models clustered by cardiologists were used to determine the impact of cardiologists on the likelihood of 1-year AVR treatment. Within 1 year of diagnosis, 35.6% of patients with ssAS received an AVR; however, rates varied widely among managing cardiologists (0%, lowest quar-tile; 100%, highest quartile [median, 29.6%; 25th–75th percentiles, 13.3%–47.0%]). The odds of receiving AVR varied >2-fold depending on the cardiologist (median odds ratio for AVR, 2.25; 95% CI, 2.14–2.36). Compared with patients with ssAS of cardiologists with the highest treatment rates, those treated by cardiologists with the lowest AVR rates experienced significantly higher 1-year mortality (lowest quartile, adjusted hazard ratio, 1.22, 95% CI, 1.13–1.33). CONCLUSIONS: Overall AVR rates for ssAS were low, highlighting a potential challenge for ssAS management in the United States. Cardiologist AVR use varied substantially; patients treated by cardiologists with lower AVR rates had higher mortality rates than those treated by cardiologists with higher AVR rates.
AB - BACKGROUND: Patients with symptomatic severe aortic stenosis (ssAS) have a high mortality risk and compromised quality of life. Surgical/transcatheter aortic valve replacement (AVR) is a Class I recommendation, but it is unclear if this recommendation is uniformly applied. We determined the impact of managing cardiologists on the likelihood of ssAS treatment. METHODS AND RESULTS: Using natural language processing of Optum electronic health records, we identified 26 438 patients with newly diagnosed ssAS (2011–2016). Multilevel, multivariable Fine-Gray competing risk models clustered by cardiologists were used to determine the impact of cardiologists on the likelihood of 1-year AVR treatment. Within 1 year of diagnosis, 35.6% of patients with ssAS received an AVR; however, rates varied widely among managing cardiologists (0%, lowest quar-tile; 100%, highest quartile [median, 29.6%; 25th–75th percentiles, 13.3%–47.0%]). The odds of receiving AVR varied >2-fold depending on the cardiologist (median odds ratio for AVR, 2.25; 95% CI, 2.14–2.36). Compared with patients with ssAS of cardiologists with the highest treatment rates, those treated by cardiologists with the lowest AVR rates experienced significantly higher 1-year mortality (lowest quartile, adjusted hazard ratio, 1.22, 95% CI, 1.13–1.33). CONCLUSIONS: Overall AVR rates for ssAS were low, highlighting a potential challenge for ssAS management in the United States. Cardiologist AVR use varied substantially; patients treated by cardiologists with lower AVR rates had higher mortality rates than those treated by cardiologists with higher AVR rates.
KW - Aortic valve replacement
KW - Physician variability
KW - Symptomatic severe aortic stenosis
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U2 - 10.1161/JAHA.120.020490
DO - 10.1161/JAHA.120.020490
M3 - Article
C2 - 34387116
AN - SCOPUS:85114365002
SN - 2047-9980
VL - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 16
M1 - e020490
ER -