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

Richard P. Steeds, Matthias Lutz, Jeetendra Thambyrajah, Antonio Serra, Eberhard Schulz, Jiri Maly, Marco Aiello, Tanja K. Rudolph, Guy Lloyd, Alessandro Santo Bortone, Karl Eugen Hauptmann, Alberto Clerici, Georg Delle-Karth, Johannes Rieber, Ciro Indolfi, Massimo Mancone, Loic Belle, Alexander Lauten, Martin Arnold, Berto J. BoumaCornelia Deutsch, Jana Kurucova, Martin Thoenes, Peter Bramlage, Norbert Frey, David Messika-Zeitoun

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)e013160
JournalJournal of the American Heart Association
Volume8
Issue number19
DOIs
Publication statusPublished - Oct 1 2019

Keywords

  • aortic stenosis
  • facilitated data relay
  • Quality of care
  • surgical aortic valve replacement
  • transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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