Health Policy & Quality Improvement

Closing the Gap: What the AHA Target: AS Registry Reveals About Real-World Aortic Stenosis Care

A year of registry data shows diagnosis is getting faster, but timely treatment is holding steady at roughly 1-in-6 patients still missing the window.

Aortic stenosis remains one of the most consequential and most frequently mismanaged valve diseases in adult cardiology.

The Target: AS registry, sponsored nationally by Edwards Lifesciences (NYSE: EW, ~$91/share), just produced its first large-scale, multi-center analysis of whether a structured quality program actually changes practice patterns.

Findings were presented at New York Valves 2026 and published simultaneously in Circulation.

The cohort included 8,097 patients with moderate or severe AS across 58 active sites enrolled by 2023, drawn from a broader registry of nearly 17,600 patient records spanning 92 centers.

Over one year, the proportion of patients receiving a timely diagnosis, defined as symptom assessment, LVEF, and stroke volume index and/or multimodal imaging within 30 days of echocardiography, rose from 54.2% to 61.4%.

Despite that gain, the rate of timely treatment among patients with a class 1 indication for aortic valve replacement (AVR) was essentially unchanged, 82.2% versus 84.7%, meaning roughly one in six eligible patients still missed the 90-day treatment window.

Timely Diagnosis Components, 2023 vs. 2024 (Long-Term Sites)

Symptom assessment

76.8%→84.0%

Stroke volume index on echo

64.7%→81.6%

Multimodal imaging use

13.4%→24.5%

Multidisciplinary team evaluation

77.6%→83.9%

Improved significantly (P<0.05) Improved but still low absolute rate

Where the System Is Still Leaking Patients

The registry's most clinically actionable finding is not the headline diagnosis number but the granular breakdown of where care still stalls.

Echocardiography reports included key structural findings 83-85% of the time, yet a discrete clinical recommendation appeared in only 9.0% (2023) and 6.8% (2024) of reports, a gap that discussant Dharam Kumbhani called highly amenable to system-level fixes like structured echo templates.

Even at long-standing sites, surveillance echocardiograms were missed in 40.2% of patients with severe AS and 37.1% of those with moderate AS by 2024, undermining the entire premise of watchful waiting.

Multimodal testing, which captures cases where resting Doppler is equivocal and CT-based aortic valve calcium scoring or stress echocardiography is needed to confirm severity, nearly doubled but started from a very low base (13.4% to 24.5%).

The AS Care Continuum — Where Patients Are Lost

Echo identifies moderate/severe AS

Key findings documented in report (83-85%)

Timely diagnosis completed (54.2%→61.4%)

Explicit clinical recommendation in echo report (≤9%)

Timely AVR in class 1 candidates (82.2%→84.7%)

Why the Registry May Itself Be the Intervention

A parallel and complementary signal comes from the ALERT trial, a cluster-randomized study presented at ACC 2026 showing that automated EHR notifications, generated using an AI platform from Tempus AI, increased 90-day evaluation or intervention rates from 19.9% to 24.3% across 35 hospitals.

That trial was funded in part by Medtronic (NYSE: MDT, ~$81/share), and builds on the earlier single-system DETECT AS trial, which showed similar automated alerts narrowed sex-based disparities in AVR referral.

Taken together with Target: AS, the data suggest that simply measuring and reporting back quality metrics, independent of any specific clinical intervention, may itself nudge practice patterns, though the authors caution this could partly reflect a Hawthorne effect rather than durable system change.

Procedural outcomes have already been transformed by the device side of this story: TAVR using the SAPIEN 3 platform (Edwards Lifesciences) now shows durability comparable to surgical valves out to seven years in low-risk patients, based on data from the STS/ACC TVT Registry presented at New York Valves 2026.

The clinical irony the registry exposes is that procedural excellence has outpaced the upstream referral pathway that gets patients to the cath lab or OR in the first place.

Key Players in the AS Quality and Device Ecosystem

Entity	Role	Ticker / Price (approx.)
Edwards Lifesciences	National sponsor of Target: AS; SAPIEN TAVR platform	NYSE: EW, ~$91
Medtronic	ALERT trial co-funder; CoreValve/Evolut TAVR platform	NYSE: MDT, ~$81
Abbott Laboratories	Structural heart portfolio (Navitor TAVR, MitraClip)	NYSE: ABT, ~$93
Boston Scientific	ACURATE and emerging structural heart pipeline	NYSE: BSX, ~$44

Prices approximate as of late June 2026; for general orientation only, not a trading recommendation.

Case Vignette A 78-year-old man undergoes echocardiography for dyspnea and is found to have a peak aortic velocity of 4.3 m/s with preserved ejection fraction, consistent with severe high-gradient AS.

The report documents the gradient and valve area but includes no explicit recommendation for heart-team referral, and the patient is not flagged for follow-up.

Three months later he returns with syncope; only then is he referred for multidisciplinary evaluation, ultimately undergoing transcatheter AVR but after a preventable delay.

This is precisely the failure mode the Target: AS data quantify at a population level, a structurally sound diagnostic system that does not reliably translate findings into action.

Practical Takeaways for Practice

Target: AS Registry — Selected Process Metrics, 2023 vs. 2024

Metric	2023	2024	P value
Overall timely diagnosis	54.2%	61.4%	0.001
Timely AVR in class 1 candidates	82.2%	84.7%	0.299
Multidisciplinary team evaluation	77.6%	83.9%	<0.001
Echo report with clinical recommendation	9.0%	6.8%	—
Missed surveillance echo, severe AS (long-term sites)	—	40.2%	—

For employed cardiologists and structural heart programs, the actionable lesson is that structured echo reporting templates with a forced clinical-recommendation field, paired with an automated referral pathway to the valve team, are the two interventions with the clearest evidence base right now.

The proposed changes to the TAVR National Coverage Determination (NCD) make this more than an academic exercise, since referral-pathway performance may increasingly intersect with how programs are evaluated and reimbursed.

The American Heart Association's Heart Valve Initiative, the planned successor to Target: AS, intends to expand the same accountability framework to mitral and tricuspid disease across up to 200 hospitals.

Bottom Line Registry participation appears to genuinely accelerate diagnostic processes in aortic stenosis, but treatment-rate gains have lagged, and the data point squarely to the echo-to-referral handoff as the highest-yield target for local quality improvement.

This article is intended for physician education and general clinical awareness; it does not substitute for individualized patient assessment, institutional protocols, or current society guidelines. Investment-related content is for general informational purposes only, does not constitute personalized financial advice, and past stock performance does not predict future results.

References

1. American Heart Association. Target: Aortic Stenosis program overview.
2. TCTMD. Clinician EHR Alerts Lead to Speedier Evaluation, Treatment of Valve Disease (ALERT trial), 2026.
3. TCTMD. RCT, Real-World Data Show TAVI Durability Up to 7 Years in Low-Risk Patients, New York Valves 2026.
4. American Heart Association Newsroom. Heart Valve Initiative announcement.