Treatment Pathways After Echocardiography-Confirmed Aortic Stenosis in Singapore: A Retrospective Cohort Study
Main Applicant – A/Prof Muhandiramalage Sanjeewa Madura Kularatna, Signature Research Programme in Health Services & Systems Research, Duke-NUS

Aortic stenosis is a common heart valve disease in older adults. When it is severe and causes symptoms, replacing the valve through surgery or a catheter procedure is the only proven treatment. However, many people who are diagnosed may not receive this treatment in time.

In Singapore, we do not clearly know how many patients proceed to valve replacement after an ultrasound of the heart (echocardiogram), or where along the care pathway they drop off.

This study will track adults diagnosed aortic stenosis and follow their journey over 12 months, from diagnosis to referral, specialist/heart-team review, advanced imaging, and finally valve replacement. We will measure the proportion who receive surgery or a catheter-based valve within a year and identify the stages where patients are most likely to stop progressing. We expect that only a minority receive treatment within 12 months, with the largest drop occurring between diagnosis and referral.

By pinpointing these gaps, our work can guide service redesign, improve referrals, and support timely treatment, ultimately helping patients live longer and feel better.