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

RP. Steeds, M. Lutz, J. Thambyrajah, A. Serra, E. Schulz, J. Maly, M. Aiello, TK. Rudolph, G. Lloyd, AS. Bortone, KE. Hauptmann, A. Clerici, G. Delle-Karth, J. Rieber, C. Indolfi, M. Mancone, L. Belle, A. Lauten, M. Arnold, BJ. Bouma, C. Deutsch,...

. 2019 ; 8 (19) : e013160. [pub] 20190924

Language English Country Great Britain

Document type Comparative Study, Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't

Persistent link   https://www.medvik.cz/link/bmc20028803

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.

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$a 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.
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$a Lutz, Matthias $u Department of Cardiology and Angiology University of Kiel Germany.
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$a Schulz, Eberhard $u Cardiology Department I University Clinic Mainz Germany.
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$a Maly, Jiri $u Department of Cardiovascular Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic. Department of Cardiovascular Surgery Second Faculty of Medicine Charles University Prague Czech Republic.
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$a Aiello, Marco $u Department of Cardiothoracic Surgery Foundation IRCCS Policlinico S.Matteo Pavia Italy.
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$a Rudolph, Tanja K $u Department of Cardiology University of Cologne Heart Center Cologne Germany.
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$a Lloyd, Guy $u St Bartholomew's Hospital London UK.
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$a Rieber, Johannes $u Herzkatheterlabor Nymphenburg and Department of Cardiology University of Munich Germany.
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$a Arnold, Martin $u Department of Cardiology University Hospital Erlangen Germany.
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$a Bouma, Berto J $u University of Amsterdam Netherlands.
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$a Messika-Zeitoun, David $u University of Ottawa Heart Institute Ottawa Canada.
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