Facilitated Data Relay and Effects on Treatment of Severe Aortic Stenosis in Europe
Por:
Steeds, RP, Lutz, M, Thambyrajah, J, Serra, A, Schulz, E, Maly, J, Aiello, M, Rudolph, TK, Lloyd, G, Santo Bortone, A, Hauptmann, KE, Clerici, A, Delle-Karth, G, Rieber, J, Indolfi, C, Mancone, M, Belle, L, Lauten, A, Arnold, M, Bouma, BJ, Deutsch, C, Kurucova, J, Thoenes, M, Bramlage, P, Frey, N, Messika-Zeitoun, D
Publicada:
1 oct 2019
Resumen:
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.
Filiaciones:
Steeds, RP:
Queen Elizabeth Hosp, Mindelsohn Way, Birmingham B15 2TT, W Midlands, England
Univ Birmingham, Inst Cardiovasc Sci, Birmingham, W Midlands, England
Lutz, M:
Univ Kiel, Dept Cardiol & Angiol, Kiel, Germany
Thambyrajah, J:
James Cook Hosp, Middlesbrough, Cleveland, England
Serra, A:
Hosp Santa Creu & Sant Pau, Intervent Cardiol Unit, Barcelona, Spain
Schulz, E:
Univ Clin Mainz, Cardiol Dept 1, Mainz, Germany
Maly, J:
Inst Clin & Expt Med, Dept Cardiovasc Surg, Prague, Czech Republic
Charles Univ Prague, Dept Cardiovasc Surg, Fac Med 2, Prague, Czech Republic
Aiello, M:
Fdn IRCCS Policlin S Matteo, Dept Cardiothorac Surg, Pavia, Italy
Rudolph, TK:
Univ Cologne, Ctr Heart, Dept Cardiol, Cologne, Germany
Lloyd, G:
St Bartholomews Hosp, London, England
Santo Bortone, A:
Univ Bari, Bari, Italy
Hauptmann, KE:
Krankenhaus Barmherzigen Bruder Trier, Trier, Germany
Clerici, A:
Univ Turin, Turin, Italy
Delle-Karth, G:
Hietzing Hosp, Dept Med 4, Vienna, Austria
Rieber, J:
Univ Munich, Herzkatheterlab Nymphenburg, Munich, Germany
Univ Munich, Dept Cardiol, Munich, Germany
Indolfi, C:
Magna Graecia Univ Catanzaro, Div Cardiol, Catanzaro, Italy
Magna Graecia Univ Catanzaro, URT CNR IFC, Catanzaro, Italy
Mancone, M:
Sapienza Univ Rome, Rome, Italy
Belle, L:
Ctr Hosp Annecy, Metz Tessy, France
Lauten, A:
Univ Heart Ctr & Charite, German Ctr Cardiovasc Res DZHK, Berlin, Germany
Arnold, M:
Univ Hosp Erlangen, Dept Cardiol, Erlangen, Germany
Bouma, BJ:
Univ Amsterdam, Amsterdam, Netherlands
Deutsch, C:
Inst Pharmacol & Prevent Med, Cloppenburg, Germany
Kurucova, J:
Edwards Lifesci, Nyon, Switzerland
Thoenes, M:
Edwards Lifesci, Nyon, Switzerland
Bramlage, P:
Inst Pharmacol & Prevent Med, Cloppenburg, Germany
Frey, N:
Univ Kiel, Dept Cardiol & Angiol, Kiel, Germany
Messika-Zeitoun, D:
Univ Ottawa, Inst Heart, Ottawa, ON, Canada
Gold, Green Published
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