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

• Published in: Journal of the American Heart Association 2019-10, Vol.8 (19), p.e013160-e013160
• Main 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
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; aortic stenosis; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - nursing; Aortic Valve Stenosis - therapy; Balloon Valvuloplasty - adverse effects; Clinical Decision-Making; Cross-Sectional Studies; Echocardiography; Eligibility Determination; Europe; facilitated data relay; Female; Heart Valve Prosthesis Implantation - adverse effects; Humans; Male; Nurse's Role; Original Research; Patient Selection; Prospective Studies; Quality of care; Referral and Consultation; Registries; Severity of Illness Index; surgical aortic valve replacement; Time Factors; Time-to-Treatment; transcatheter aortic valve implantation; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome; Watchful Waiting
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.119.013160

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%, =0.002) and a significant decrease in the time to intervention (36±38 versus 30±33 days, =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.