A joint effort from all stakeholders may be the only way achieve equitable and broad application of aortic stenosis (AS) treatment and other novel structural heart disease treatment modalities, according to a perspective from ACC's Interventional Section Leadership Council published Oct. 28 in the Journal of the American College of Cardiology.

Wayne B. Batchelor, MD, FACC, et al., review the underdiagnosis and treatment of AS in underserved populations and discuss how the issue might be best addressed. Although SAVR and TAVR have been dramatically improving prognosis, the authors explain these modalities have not been equally disseminated across the spectrum of patients afflicted with AS, particularly in underserved minorities. They add that reasons for treatment gaps may include differences in disease prevalence as well as patient, health care system and disease-related factors.

The authors propose a four-part intervention aimed at narrowing this treatment gap, including implementation of measure-based quality improvement programs; effective culturally competent communication and team-based care; improving patient health care access, education and effective diagnosis; and changing the research paradigm that creates an innovation pipeline for patients.

Furthermore, the authors note that the "underserved" populations may include not only minorities but also patients who may have restricted access to aortic valve replacement due to other factors, including living conditions or geography.

"There remains a long road ahead to achieving equitable access to TAVR and other innovative treatments for valvular heart disease," the authors conclude. "In the end, only a concerted effort from stakeholders will allow us to better 'serve the underserved' with these life-saving interventions."

Keywords: Aortic Valve, Transcatheter Aortic Valve Replacement, Social Conditions, Vulnerable Populations, Quality Improvement, Aortic Valve Stenosis, Heart Valve Diseases, Health Services Accessibility, Prognosis

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