{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:08:37Z","timestamp":1791248917886,"version":"4.1.0"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,6,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Many patients with severe aortic stenosis (AS) and an indication for aortic valve replacement (AVR) do not undergo treatment. The reasons for this have not been well studied in the transcatheter AVR era. We sought to determine how patient\u2010 and process\u2010specific factors affected AVR use in patients with severe AS.<\/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\">\n              We identified ambulatory patients from 2016 to 2018 demonstrating severe AS, defined by aortic valve area\n              <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                <mml:mo>\u2264<\/mml:mo>\n              <\/mml:math>\n              1.0\u00a0cm\n              <jats:sup>2<\/jats:sup>\n              . Propensity scoring analysis with inverse probability of treatment weighting was used to evaluate associations between predictors and the odds of undergoing AVR at 365\u00a0days and subsequent mortality at 730\u00a0days. Of 324 patients with an indication for AVR (79.3\u00b19.7\u00a0years, 57.4% men), 140 patients (43.2%) did not undergo AVR. The odds of AVR were reduced in patients aged &gt;90\u00a0years (odds ratio [OR], 0.24 [95% CI, 0.08\u20130.69];\n              <jats:italic>P<\/jats:italic>\n              =0.01), greater comorbid conditions (OR, 0.88 per 1\u2010point increase in Combined Comorbidity Index [95% CI, 0.79\u20130.97];\n              <jats:italic>P<\/jats:italic>\n              =0.01), low\u2010flow, low\u2010gradient AS with preserved left ventricular ejection fraction (OR, 0.11 [95% CI, 0.06\u20130.21]), and low\u2010gradient AS with reduced left ventricular ejection fraction (OR, 0.18 [95% CI, 0.08\u20130.40]) and were increased if the transthoracic echocardiogram ordering provider was a cardiologist (OR, 2.46 [95% CI, 1.38\u20134.38]). Patients who underwent AVR gained an average of 85.8\u00a0days of life (95% CI, 40.9\u2013130.6) at 730\u00a0days.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">The proportion of ambulatory patients with severe AS and an indication for AVR who do not receive AVR remains significant. Efforts are needed to maximize the recognition of severe AS, especially low\u2010gradient subtypes, and to encourage patient referral to multidisciplinary heart valve teams.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.121.025065","type":"journal-article","created":{"date-parts":[[2022,5,27]],"date-time":"2022-05-27T11:09:48Z","timestamp":1653649788000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":25,"title":["Patient\u2010 and Process\u2010Related Contributors to the Underuse of Aortic Valve Replacement and Subsequent Mortality in Ambulatory Patients With Severe Aortic Stenosis"],"prefix":"10.1161","volume":"11","author":[{"given":"Laura","family":"Flannery","sequence":"first","affiliation":[{"name":"Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston 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