In a large cohort of patients with aortic stenosis (AS) who had equal access to medical care and insurance, those who lived in the most socioeconomically deprived neighborhoods were less likely to complete surveillance transthoracic echocardiography (TTE) at the guideline recommended times, according to findings from a retrospective study published Oct. 29 in JACC.

Salam Allahwerdy, BS, et al., analyzed data from 33,346 patients with AS (median age, 74 years; 46% women) in the Kaiser Permanente Southern California integrated health care system. Of the patients, 60% are White, 24% Hispanic, 8% Asian and 7% Black. Researches assessed rates of TTE surveillance as well as demographic, clinical and socioeconomic factors associated with guideline adherence to follow-up imaging. Adherence was defined as repeat TTE within five years for mild (56% of patients), two years for moderate (28%) and one year for severe (16%) AS.

Results showed that 87% of patients had a repeat TTE: 80% of those with mild AS, 94% with moderate and 97% with severe. The median time to repeat TTE was 459 days, including 694 days for those with mild AS, 398 days for moderate AS and 173 days for severe AS. Three-quarters of patients completed surveillance TTE within guideline-recommended timeframes.

Notably, women were less likely than men to complete timely surveillance TTE (odds ratio [OR], 0.92). Likewise, patients in neighborhoods with higher deprivation were less likely to complete timely surveillance, with the lowest odds in those with the most deprived quintile (OR, 0.70).

In other findings, those less likely to complete timely surveillance were patients aged ≥80 years, whereas those with cardiac comorbidities had higher odds of completing surveillance. Regarding all-cause mortality, an exploratory analysis found that patients living in the most deprived neighborhoods had the highest risk (hazard ratio, 1.09).

"The finding that inequities persist even in systems with equal health care access highlights the role of social barriers to care outside the medical system," write the authors. Transportation challenges, competing work and caregiving responsibilities, limited health literacy and reduced understanding of the importance of ongoing monitoring play a critical role, they note.

The authors write, "These findings underscore the need for targeted, equity-focused interventions to promote timely follow-up and reduce gaps in care." They note that "expanding patient educational resources that are linguistically appropriate and culturally relevant could help bridge knowledge gaps and empower patients to engage in timely, guideline-recommended surveillance."