Improving Symptom Detection and Early Intervention in Aortic Stenosis

At the American Heart Association Scientific Sessions 2025 in New Orleans, Sammy Elmariah, MD, MPH, FAHA, discussed the importance of recognizing subtle and often overlooked signs of valvular heart disease progression in elderly populations. He emphasized that current clinical practice frequently relies on patient-reported symptoms to trigger intervention, yet many patients misattribute worsening functional decline to normal aging. Elmariah noted that family members are often the first to notice changes, and patients commonly realize how symptomatic they were only after treatment restores their true functional capacity. He encouraged clinicians and patients to monitor for small but rapid declines in exercise tolerance or daily activity, highlighting that such insidious changes should prompt timely evaluation to avoid delays in care.

Pharmacy Times: This initiative plans to expand data collection and develop hospital certification programs—how do you envision these efforts improving adherence to guideline-based care and overall patient outcomes?

Sammy Elmariah, MD, MPH, FAHA: Now it has been reproduced over and over again. The Target: AS initiative has been launched, and there is tremendous momentum to not only continue to learn about the obstacles and barriers to care but also to improve the care that we are delivering through the certification program. Again, what it is hopefully going to do—and the entire heart valve initiative—is allow hospitals to learn how they are actually doing, which may be surprising, as few hospitals actually recognize their performance. Once people recognize that we are all trying to do the best we can for our patients, that realization alone, I think, is going to move the needle as centers try to improve their own performance. The certification adds another carrot to hopefully allow centers to continue their efforts to improve the care and quality they are delivering for aortic stenosis and other forms of valvular heart disease.
Pharmacy Times: As heart valve disease prevalence rises with age, what key messages or educational priorities should health professionals emphasize to raise awareness and encourage proactive evaluation among at-risk populations?

Elmariah: Current clinical practice focuses largely on symptomatology as the trigger at which we start to intervene. In elderly patients, the assessment of symptoms and the determination of what is causing those symptoms can often be much more challenging. The reason is that many of the valve lesions develop and cause symptoms in a very insidious fashion. Many of our patients come to us and swear up and down that they are asymptomatic, that they are doing fine. You look at their spouse, and they tell you, “Oh no, he or she is slowing down.” Then, of course, once you point that detail out, they attribute it to just aging.

It is not until you fix the problem—after convincing them that the progression of symptoms is atypical even for someone of their age—that they realize how good they can feel and then recognize how symptomatic they truly were. So, what I would encourage providers to do, and what I hope patients will also recognize, is that when we say symptomatic, it does not mean that they are huffing and puffing and having to stop every time they walk a block or go up a flight of stairs. It can be much more subtle. Aging is not usually associated with a rapid decline in functional capacity over a month or two. So, when those sorts of subtle changes start to happen, you really have to pay attention, think about what is wrong, and get evaluated.