Facilitated Data Relay and Effects on Treatment of Severe Aortic Stenosis in Europe

Author:

Steeds Richard P.1,Lutz Matthias2,Thambyrajah Jeetendra3,Serra Antonio4,Schulz Eberhard5,Maly Jiri67,Aiello Marco8,Rudolph Tanja K.9,Lloyd Guy10,Bortone Alessandro Santo11,Hauptmann Karl Eugen12,Clerici Alberto13,Delle‐Karth Georg14,Rieber Johannes15,Indolfi Ciro16,Mancone Massimo17,Belle Loic18,Lauten Alexander19,Arnold Martin20,Bouma Berto J.21,Deutsch Cornelia22,Kurucova Jana23,Thoenes Martin23,Bramlage Peter22,Frey Norbert2,Messika‐Zeitoun David24

Affiliation:

1. Queen Elizabeth Hospital & Institute of Cardiovascular Sciences University of Birmingham UK

2. Department of Cardiology and Angiology University of Kiel Germany

3. James Cook Hospital Middlesbrough UK

4. Interventional Cardiology Unit, Hospital de la Santa Creu i Sant Pau Barcelona Spain

5. Cardiology Department I University Clinic Mainz Germany

6. Department of Cardiovascular Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic

7. Department of Cardiovascular Surgery Second Faculty of Medicine Charles University Prague Czech Republic

8. Department of Cardiothoracic Surgery Foundation IRCCS Policlinico S.Matteo Pavia Italy

9. Department of Cardiology University of Cologne Heart Center Cologne Germany

10. St Bartholomew's Hospital London UK

11. University of Bari Italy

12. Krankenhaus der Barmherzigen Brüder Trier Germany

13. University of Turin Italy

14. 4th Medical Department Hietzing Hospital Vienna Austria

15. Herzkatheterlabor Nymphenburg and Department of Cardiology University of Munich Germany

16. Division of Cardiology and URT CNR of IFC University Magna Graecia Catanzaro Italy

17. Sapienza University of Rome Italy

18. Centre Hospital d'Annecy France

19. German Centre for Cardiovascular Research (DZHK) University Heart Center & Charité Berlin Germany

20. Department of Cardiology University Hospital Erlangen Germany

21. University of Amsterdam Netherlands

22. Institute for Pharmacology and Preventive Medicine Cloppenburg Germany

23. Edwards Lifesciences Nyon Switzerland

24. University of Ottawa Heart Institute Ottawa Canada

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: NCT 02241447.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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