One in Six Aortic Stenosis Patients Miss Timely Treatment Despite Diagnostic Gains
A national US registry shows diagnosis of aortic stenosis is improving, but treatment delays still leave many eligible patients without valve replacement in time.
Summary
Aortic stenosis (AS), a dangerous narrowing of the heart's main valve, is being diagnosed faster in the US — but treatment gaps remain serious. A 2024 national registry study found that 61% of moderate-to-severe AS patients received full diagnostic workups within 30 days, up from 54% in 2023. However, nearly one in six patients eligible for aortic valve replacement (AVR) still did not receive it within 90 days. Presented at the New York Valves meeting and published in Circulation, the study draws on data from 58 US hospital sites. Experts note that TAVR — the minimally invasive valve replacement procedure — has dramatically cut one-year mortality from roughly 50% to under 2%, making timely access to it a critical health issue.
Detailed Summary
Aortic stenosis, a progressive and potentially fatal narrowing of the aortic heart valve, affects a growing number of older adults. Early and accurate diagnosis followed by timely intervention is essential — yet a major US care quality registry reveals persistent gaps that put patients at risk.
The American Heart Association's Target: Aortic Stenosis registry, drawing on randomly selected patients from 58 US sites, found that 61.4% of patients with moderate or severe AS completed all confirmatory diagnostic assessments within 30 days in 2024, up from 54.2% in 2023 — a statistically significant improvement. However, among those with a clear clinical indication for aortic valve replacement (AVR), 84.7% received treatment within 90 days in 2024, a figure not significantly changed from 82.2% in 2023. This means roughly one in six eligible patients did not receive AVR on time.
The consequences are not trivial. Before transcatheter aortic valve replacement (TAVR) became widespread, one-year mortality for severe AS approached 50%. In the current low-risk TAVR era, that figure has fallen to approximately 1–2%. That transformation makes timely diagnosis and treatment more important than ever — and delays more costly in relative terms.
Diagnostic bottlenecks identified in the registry include failure to assess symptoms promptly and incomplete reporting of stroke volume index or multimodality imaging needed to confirm AS severity. These upstream gaps delay the path to intervention.
The report arrives as the US Centers for Medicare and Medicaid Services (CMS) has proposed significant changes to TAVR coverage, including removing procedural volume requirements for facilities and expanding coverage to asymptomatic severe AS patients. These changes could increase TAVR access, though prior research warns that rapid adoption phases have historically been associated with longer wait times and increased mortality. Addressing diagnostic quality alongside expanded access will be critical to realizing the full benefit of TAVR for patients.
Key Findings
- 61.4% of AS patients received full diagnostic workup within 30 days in 2024, up from 54.2% in 2023.
- Nearly 1 in 6 patients with a clear AVR indication still did not receive valve replacement within 90 days.
- TAVR has reduced one-year AS mortality from ~50% in the pre-TAVR era to just 1–2% today.
- Incomplete symptom assessment and missing stroke volume index data are key upstream diagnostic barriers.
- Proposed CMS rule changes could expand TAVR access but may risk longer wait times during rapid adoption.
Methodology
This is a meeting coverage news report summarizing a registry study presented at the New York Valves annual meeting and simultaneously published in Circulation, a high-impact peer-reviewed journal. The registry drew on randomly selected patients from 58 US hospital sites in 2023 and 2024, providing a nationally representative sample. Evidence quality is observational and registry-based, not a randomized controlled trial.
Study Limitations
The registry is observational and limited to 58 voluntary participating US sites, which may not fully represent all clinical settings. The article is a news summary of a conference presentation, and some details may not reflect the full published manuscript. Causality between diagnostic delays and mortality outcomes cannot be established from registry data alone.
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