Facilitated Data Relay and Effects on Treatment of Severe Aortic Stenosis in Europe. Issue 19 (1st October 2019)

• Record Type: Journal Article
• Authors: Steeds, Richard P.; Lutz, Matthias; Thambyrajah, Jeetendra; Serra, Antonio; Schulz, Eberhard; Maly, Jiri; Aiello, Marco; Rudolph, Tanja K.; Lloyd, Guy; Bortone, Alessandro Santo; Hauptmann, Karl Eugen; Clerici, Alberto; Delle‐Karth, Georg; Rieber, Johannes; Indolfi, Ciro; Mancone, Massimo; Belle, Loic; Lauten, Alexander; Arnold, Martin; Bouma, Berto J.; Deutsch, Cornelia; Kurucova, Jana; Thoenes, Martin; Bramlage, Peter; Frey, Norbert; Messika‐Zeitoun, David
• Is Part Of: Journal of the American Heart Association. Volume 8:Issue 19(2019)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2019-10-01
• Subjects: Quality of care -- aortic stenosis -- transcatheter aortic valve implantation -- surgical aortic valve replacement -- facilitated data relay; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cerebrovascular disease -- Periodicals; Cardiology -- Periodicals; 616.1
• DOI: 10.1161/JAHA.119.013160
• Languages: English
• ISSNs: 2047-9980

Abstract

Abstract : Background: Many patients with severe aortic stenosis are referred late with advanced symptoms or inappropriately denied intervention. The objective was to investigate whether a structured communication to referring physicians (facilitated data relay) might improve the rate and timeliness of intervention. Methods and Results: A prospective registry of consecutive patients with severe aortic stenosis at 23 centers in 9 European countries with transcatheter as well as surgical aortic valve replacement being available was performed. The study included a 3‐month documentation of the status quo (phase A), a 6‐month intervention phase (implementing facilitated data relay), and a 3‐month documentation of a legacy effect (phase‐B). Two thousand one hundred seventy‐one patients with severe aortic stenoses were enrolled (phase A: 759; intervention: 905; phase‐B: 507). Mean age was 77.9±10.0 years, and 80% were symptomatic, including 52% with severe symptoms. During phase A, intervention was planned in 464/696 (67%), 138 (20%) were assigned to watchful waiting, 8 (1%) to balloon aortic valvuloplasty, 60 (9%) were listed as not for active treatment, and in 26 (4%), no decision was made. Three hundred sixty‐three of 464 (78%) patients received the planned intervention within 3 months. Timeliness of the intervention improved as shown by the higher number of aortic valve replacements performed within 3 months (59% versus 51%, P =0.002) and a significant decrease in the time to intervention (36±38 versus 30±33 days, P =0.002). Conclusions: A simple, low‐cost, facilitated data relay improves timeliness of treatment for patients diagnosed with severe aortic stenosis, resulting in a shorter time to transcatheter aortic valve replacement. This effect was mainly driven by a significant improvement in timeliness of intervention in transcatheter aortic valve replacement but not surgical aortic valve replacement. Clinical Trial Registration: URL: https://www.clinicaltrials.gov/ . Unique identifier: NCT02241447.