Aortic stenosis silently narrows its window for intervention — and tens of thousands of Americans are falling through gaps in the diagnosis-to-treatment pipeline. A condition where delayed care translates directly into measurable mortality, AS has long suffered from a quality blind spot: most registries tracked what happened in the operating room, not the months before a patient ever got there. This national effort changes that calculus.
The AHA Target: AS registry enrolled 8,097 patients with moderate or severe aortic stenosis across 58 U.S. sites in 2023–2024. Two primary quality metrics anchored the analysis: timely diagnosis — defined as completing all clarifying assessments within 30 days of an echocardiogram suggesting possible severe AS — and timely treatment, meaning aortic valve replacement within 90 days of a Class I guideline indication. Timely diagnosis reached only 54% in 2023, nudging to 61% in 2024. Persistent gaps were traced to delayed symptom assessment and missing stroke volume index measurements, a hemodynamic parameter critical for distinguishing true-severe from pseudo-severe AS. The cohort was 47% women, with modest representation from Black, Hispanic, and Asian patients — demographics historically undertreated in structural heart disease.
This registry represents a meaningful methodological advance by shifting quality measurement upstream, toward the diagnostic and surveillance phases where correctable delays accumulate. The finding that roughly 4 in 10 patients still don't receive timely diagnostic clarification — even in 2024 — underscores a systemic gap that procedural metrics would never capture. The improvement in stroke volume index documentation (from 35% missing to 18% missing in one year) suggests that measurement feedback loops can drive rapid, meaningful change. However, the registry's voluntary and site-selected design limits generalizability; community hospitals without dedicated valve programs almost certainly perform worse. Whether these quality improvements translate into survival gains remains to be demonstrated prospectively. Still, as transcatheter aortic valve replacement continues to lower the procedural threshold for intervention, upstream care quality will increasingly determine which patients ever reach the table.