Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Oct 2019)

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. Bouma,
  • Cornelia Deutsch,
  • Jana Kurucova,
  • Martin Thoenes,
  • Peter Bramlage,
  • Norbert Frey,
  • David Messika‐Zeitoun

DOI
https://doi.org/10.1161/JAHA.119.013160
Journal volume & issue
Vol. 8, no. 19

Abstract

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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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