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An ECHO is a common diagnostic tool required in diagnosing severe aortic stenosis (AS). However, not all Medicare patients receive an ECHO, making AS undetectable. The objective of this study was to examine the rate of ECHO testing and the prevalence of undiagnosed AS using the Medicare fee-for-service (FFS) database.
This is a retrospective analysis using the Medicare FFS 5% sample database from 2011 through 2014. Patients were divided into 2 cohorts, those with a record of 1 or more ECHOs and those with no record of an ECHO anytime in the database. Patient demographics and comorbid conditions were recorded at time zero, which was either set as the first record of a patients’ ECHO or randomly assigned for patients with no record of an ECHO. Patients were followed until they dropped out of the database, received a diagnosis of AS, or died.
Of the 3,113,990 Medicare patients examined from 2011 to 2014, 2,259,497 (73%) had no record of receiving an ECHO anytime in the database. For the 854,493 (27%) that had a record of 1 or more ECHOs, 205,875 (24%) had a diagnosis of AS within 6 months of their ECHO and 8,637 (4.2%) of those patients had a record of surgical treatment. Although patients with AS who had surgeries were younger than patients who did not, both groups had similar comorbid profiles. Patients with AS were older (more than half were greater than or equal to 75 years of age) and sicker (with higher rates of atrial fibrillation [AFIB], chronic obstructive pulmonary disease [COPD], hypertension, and stroke) than patients without AS. Compared with patients who had a record of an ECHO, those without a recorded ECHO were younger (only 20% were aged 75 years or older) and over half of the patients (1,174,938) had no record of COPD, diabetes, stroke, heart failure, hypertension or hyperlipidemia. The remaining 1,084,559 patients had lower rates of comorbidities than patients with an ECHO; however, 813,419 had 2 or more of these comorbid conditions, putting them at higher risk for having undiagnosed AS.
Prevalence of patients in the Medicare population receiving an ECHO is about 27%, and of those patients, the AS diagnosis is about 1 in 4. Patients aged 75 years or older with increased risk factors for AS like hypertension, diabetes, COPD, and stroke may be considered for a routine ECHO to detect severe AS.