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Aortic Stenosis: Diagnosis and Treatment

Hiten Patel, MD, MPH
Benjamin W. Lewis, MD
Ryan Paulus, DO

American Family Physician. 2026;114(2):148-155.

Author Disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Aortic stenosis is the most common valvular heart disease in the United States, and it affects up to 3.7% of the general population. Atherosclerosis results in progressive calcification of the aortic valve, leading to valve narrowing. Aortic stenosis is more common in older adults and men and in those with bicuspid aortic valves or cardiovascular risk factors. Classic symptoms of aortic stenosis include exertional angina, dyspnea, syncope, presyncope, and symptoms of heart failure. Patients may present with atypical symptoms (eg, fatigue, exercise intolerance), which may be mistaken for other cardiopulmonary conditions or attributed to aging. Transthoracic echocardiography is the preferred test for diagnosis because it can classify the severity of aortic stenosis. Asymptomatic patients with aortic stenosis may be monitored with echocardiography every 3 to 5 years for mild stenosis, 1 to 2 years for moderate stenosis, and 6 to 12 months for severe stenosis. No specific treatment prevents the need for aortic valve replacement or reverses aortic stenosis. Aortic valve replacement is indicated in patients with symptomatic severe aortic stenosis and in a subset of those with asymptomatic severe stenosis. There is no difference in mortality between transcatheter aortic valve replacement and surgical valve replacement.

Aortic stenosis is the most common valvular heart disease in the United States, with an estimated prevalence of up to 3.7% in the general population.1,2 Aortic stenosis affects only 0.2% of those in their 50s. Rates of aortic stenosis increase with age, affecting 1.3% of individuals in their 60s, 3.9% in their 70s, and 9.8% in their 80s.3 Prevalence of aortic stenosis has increased over the past several decades and is predicted to continue to rise over the next 25 years.4,5 Individuals with untreated, symptomatic severe aortic stenosis have an estimated 2-year mortality rate of 50%.6 In 2017, more than 100,000 deaths worldwide were attributed to aortic stenosis, and the United States had one of the highest age-standardized mortality rates.7

WHAT'S NEW ON THIS TOPIC

Aortic Stenosis
The inability to differentiate symptoms of aortic stenosis from those of atrial fibrillation may lead to lower rates of aortic valve replacement. A retrospective study found that 16% of patients with aortic stenosis had concurrent atrial fibrillation and that this group had a lower rate of aortic valve replacement at 1 year (hazard ratio = 0.73).
In patients with previous TAVR, a meta-analysis found that using angiotensin-converting enzyme inhibitors and angiotensin receptor blockers resulted in a lower risk of mortality (RR = 0.74) and new-onset atrial fibrillation (RR = 0.71).
Patients who undergo TAVR are at higher risk of vascular complications and the need for a pacemaker or reintervention. Patients who undergo surgical valve replacement are at higher risk of new-onset atrial fibrillation and severe bleeding.

RR= relative risk; TAVR = transcatheter aortic valve replacement.

Most patients with aortic stenosis are asymptomatic initially, but symptoms may develop as the disease progresses to severe stenosis, leading to the need for valve replacement. Management of aortic stenosis is nuanced, and the decision to perform valve replacement often requires multidisciplinary care teams.

HITEN PATEL, MD, MPH, FAAFP, is associate program director and an associate professor in the Department of Family and Community Medicine at Ohio State University Wexner Medical Center, Columbus.

BENJAMIN W. LEWIS, MD, is a resident in the Department of Family and Community Medicine at Ohio State University Wexner Medical Center, Columbus.

RYAN PAULUS, DO, is an assistant professor in the Department of Family Medicine at the University of North Carolina School of Medicine, Chapel Hill.

Address correspondence to Hiten Patel, MD, MPH, at hiten.patel@osumc.edu.

Author Disclosure: No relevant financial relationships.

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