Abstract 16706: Access to Care: Geographical Variations in the Diagnosis and Treatment of Aortic Stenosis in North Carolina

Abstract

Background: Aortic stenosis (AS) affects 2-4% of those over 65 in the US, with approximately 40% of those with severe AS not receiving surgical treatment. With the emergence of new therapies for AS, insights into current geographical treatment disparities may help influence strategies to deploy these therapies to reduce potential inequalities.

Methods: Using Thomson Reuters Healthcare Indexes, we used ICD-9 diagnosis codes to identify patients hospitalized with a principal diagnosis of AS in FFY 2010 in each of NC’s 100 counties, and identified the home location of patients receiving aortic valve surgery during that same time period. Patient demographics, co-morbidities and cardiovascular procedures were assessed. The rates of AS discharges and aortic valve surgeries per 1,000 people over 65 in each NC county were calculated.

Results: There were 1,571 discharges from NC hospitals in FFY 2010 with a principal diagnosis of AS. The median age for these patients was 74 (25^th-75^th) and 43% were female. Of these, 32% had heart failure, 48% had coronary disease, and 26% had diabetes. 1,155 patients received aortic valvular surgery during that same time with a surgical mortality rate of 3.2%. The geographical distribution of the patients hospitalized for AS is shown in Figure 1a, while the geographical distribution of the home county for patients receiving valvular surgery is shown in Figure 1b. These demonstrate that the highest rates of hospitalizations for AS are in the rural corners of the state, while the highest rates of surgery are in patients living near metropolitan areas.

Conclusions: Aortic stenosis is a common discharge diagnosis in NC residents. Those living in rural regions have the highest rates of hospital admissions for AS but the lowest rates of aortic valvular surgery. Geographical disparities in AS treatment may result from differential access to therapy. Further research and coordination of care is needed as new therapies for AS are deployed.