(P194) GEOGRAPHICAL DIFFERENCES IN THE PATTERN OF NEWLY DIAGNOSED SEVERE AORTIC STENOSIS IN BRITISH COLUMBIA (B.C.)

Background: Aortic stenosis (AS) is a common valvular heart condition associated with poor prognosis. Both surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) confers survival benefit for patients with severe AS. Rural and remote residents have reduced access to health care services with barriers to specialized care due to lack of infrastructure, clinicians, and transportation. Despite these known disparities in care, little is known about how the management and outcomes of severe AS differs in rural communities as compared to their urban counterparts.

METHODS AND RESULTS: A retrospective chart review was performed on all patients with severe AS diagnosed at Vancouver General and University of British Columbia Hospitals between 2012 and 2022. For determination of rurality, BC postal codes were sorted using forward sortation area codes and categorized based on the Province of British Columbia’s Rural Practice Subsidiary Agreement classification system. We evaluated the effect of rural and urban location on clinical evaluation for and provision of SAVR and TAVR, as well as effects on cardiovascular outcomes.

In this analysis of the 10-year study period, 1794 patients with severe AS were identified, 1779 of which had a BC postal code. Of these, 201 (11.3%) were from a rural location and 1578 (88.7%) were urban. Patients from rural communities were more likely to be diagnosed with severe AS during a hospitalization (31.5%) than their urban counterparts (27.4%). Rural patients were also more likely to exhibit NYHA Class III/IV symptoms (43.4% versus 32.6%, p-value=0.002), and CCS I+ symptoms (31.3% versus 20.5%, p-value=0.001). Patients presenting from rural locations were more likely to undergo AVR workup and treatment (Table 1). There were no significant differences in cardiovascular outcomes between rural and urban populations.

Conclusion: Our data indicate that patients with severe AS from rural communities within British Columbia presented with more symptomatic disease than their urban counterparts. Patients from rural locations received AVR services at higher rates, and this may be attributable to their higher acuity (increased hospitalization) and higher symptom burden (NYHA and CCS class).