Facilitated Data Relay and Effects on Treatment of Severe Aortic Stenosis in Europe
Steeds, Richard P. (University of Birmingham)
Lutz, Matthias (University of Kiel)
Thambyrajah, Jeetendra (James Cook Hospital)
Serra Peñaranda, Antonio (Institut d'Investigació Biomèdica Sant Pau)
Schulz, Eberhard (University Clinic Mainz)
Maly, Jiri (Charles University)
Aiello, Marco (Foundation IRCCS Policlinico S.Matteo)
Rudolph, Tanja K. (University of Cologne Heart Center)
Lloyd, Guy (St Bartholomew's Hospital)
Bortone, Alessandro Santo (University of Bari)
Hauptmann, Karl Eugen (Krankenhaus der Barmherzigen Brüder Trier)
Clerici, Alberto (University of Turin)
Delle-Karth, Georg (Hietzing Hospital)
Rieber, Johannes (University of Munich)
Indolfi, Ciro (University Magna Graecia)
Mancone, Massimo (Sapienza University of Rome)
Belle, Loic (Centre Hospital d'Annecy)
Lauten, Alexander (University Heart Center & Charité)
Arnold, Martin (University Hospital)
Bouma, Berto J. (University of Amsterdam)
Deutsch, Cornelia (Institute for Pharmacology and Preventive Medicine)
Kurucova, Jana (Edwards Lifesciences)
Thoenes, Martin (Edwards Lifesciences)
Bramlage, Peter (Institute for Pharmacology and Preventive Medicine)
Frey, Norbert (University of Kiel)
Messika-Zeitoun, David (University of Ottawa Heart Institute)
Universitat Autònoma de Barcelona

Fecha:	2019
Resumen:	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.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Aortic stenosis ; Quality of care ; Facilitated data relay ; Surgical aortic valve replacement ; Transcatheter aortic valve implantation
Publicado en:	Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol. 8 Núm. 19 (january 2019) , p. e013160, ISSN 2047-9980

DOI: 10.1161/JAHA.119.013160
PMID: 31549578

16 p, 1.5 MB

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