{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T22:08:38Z","timestamp":1791410918548,"version":"4.3.3"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,8,17]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">Using natural language processing of Optum electronic health records, we identified 26\u00a0438 patients with newly diagnosed ssAS (2011\u20132016). Multilevel, multivariable Fine\u2010Gray competing risk models clustered by cardiologists were used to determine the impact of cardiologists on the likelihood of 1\u2010year AVR treatment. Within 1\u00a0year of diagnosis, 35.6% of patients with ssAS received an AVR; however, rates varied widely among managing cardiologists (0%, lowest quartile; 100%, highest quartile [median, 29.6%; 25th\u201375th percentiles, 13.3%\u201347.0%]). The odds of receiving AVR varied &gt;2\u2010fold depending on the cardiologist (median odds ratio for AVR, 2.25; 95% CI, 2.14\u20132.36). 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\u2010year mortality (lowest quartile, adjusted hazard ratio, 1.22, 95% CI, 1.13\u20131.33).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.020490","type":"journal-article","created":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T09:39:02Z","timestamp":1628847542000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Association Between Patient Survival and Clinician Variability in Treatment Rates for Aortic Valve Stenosis"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7904-285X","authenticated-orcid":false,"given":"J. 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