Further Reduction in Mortality Rates from Aortic Stenosis in the United States With Ongoing Inequities

Recent analyses have shown a reduction in mortality from aortic stenosis in the United States between 2014 and 2018, corresponding to the increase in transcatheter aortic valve replacements (TAVR). Notably, mortality due to aortic stenosis had remained unchanged in minorities and the nonmetropolitan population, signifying potential inequities in access to advanced cardiac care. 1 Bevan GH Zidar DA Josephson RA Al-Kindi SG Mortality due to aortic stenosis in the United States, 2008–2017. JAMA. 2019; 321: 2236-2238 Crossref PubMed Scopus (30) Google Scholar ,2 Khan SU Kalra A Kapadia SR Khan MU Zia Khan M Khan MS Mamas MA Warraich HJ Nasir K Michos ED Alkhouli M Demographic, regional, and state-level trends of mortality in patients with aortic stenosis in United States, 2008 to 2018. J Am Heart Assoc. 2020; 9e017433 Crossref Scopus (6) Google Scholar Since 2018, however, the number of TAVR performed in the United States has continued to increase and surpassed the total number of surgical aortic valve replacements. 3 Carroll JD Mack MJ Vemulapalli S Herrmann HC Gleason TG Hanzel G Deeb GM Thourani VH Cohen DJ Desai N Kirtane AJ Fitzgerald S Michaels J Krohn C Masoudi FA Brindis RG Bavaria JE STS-ACC TVT registry of transcatheter aortic valve replacement. J Am Coll Cardiol. 2020; 76: 2492-2516 Crossref PubMed Scopus (375) Google Scholar In addition, TAVR is now approved by the Food and Drug Administration for patients with low-risk aortic stenosis after the results of the Placement of Aortic Transcatheter Valves (PARTNER) 3 trial, which showed improved outcomes of TAVR compared to surgery. 4 Mack MJ Leon MB Thourani VH Makkar R Kodali SK Russo M Kapadia SR Malaisrie SC Cohen DJ Pibarot P Leipsic J Hahn RT Blanke P Williams MR McCabe JM Brown DL Babaliaros V Goldman S Szeto WY Genereux P Pershad A Pocock SJ Alu MC Webb JG Smith CR PARTNER 3 InvestigatorsTranscatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019; 380: 1695-1705 Crossref PubMed Scopus (2731) Google Scholar We therefore sought to assess the impact of these major changes on recent mortality rates from aortic stenosis in the US.