Severe aortic stenosis management in heart valve centres compared with primary/secondary care centres
Rudolph, Tanja K. Messika-Zeitoun, David Frey, Norbert Lutz, Matthias Krapf, Laura Passefort, Stephanie Fryearson, John Simpson, Helen Mortensen, Kai Rehse, Sebastian
Rudolph, Tanja K.
Messika-Zeitoun, David
Frey, Norbert
Lutz, Matthias
Krapf, Laura
Passefort, Stephanie
Fryearson, John
Simpson, Helen
Mortensen, Kai
Rehse, Sebastian
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Affiliation
South Warwickshire University NHS Foundation Trust; et al.
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Publication date
2023-01
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Abstract
Objective: Current guidelines recommend use of heart valve centres (HVCs) to deliver optimal quality of care for patients with valve disease but there is no evidence to support this. The hypothesis of this study is that patient care with severe aortic stenosis (AS) will differ in HVCs compared with satellite centres. We aimed to compare the treatment of patients with AS at HVCs (tertiary care hospitals with full access to AS interventions) to satellites (hospitals without such access).
Methods: IMPULSE enhanced is a European, observational, prospective registry enrolling consecutive patients with newly diagnosed severe AS at four HVCs and 10 satellites. Clinical characteristics, interventions performed and outcomes up to 1 year by site-type were examined.
Results: Among 790 patients, 594 were recruited in HVCs and 196 in satellites. At baseline, patients in HVCs had more severe valve disease (higher peak aortic velocity (4.3 vs 4.1 m/s; p=0.008)) and greater comorbidity (coronary artery disease (CAD) (44% vs 27%; p<0.001) prior myocardial infarction (MI) (11% vs 5.1%; p=0.011) and chronic pulmonary disease (17% vs 8.9%; p=0.007)) than those presenting in satellites. An aortic valve replacement was performed more often by month 3 in HVCs than satellites in the overall population (52.6% of vs 31.3%; p<0.001) and in symptomatic patients (66.7% vs 43.2%, p<0.001). One-year survival rate was higher for patients in HVCs than satellites (HR2.19; 95% CI 1.28 to 3.73 total population and 2.89 (95%CI 1.64 to 5.11) for symptomatic patients.
Conclusions: Our data support the implementation of referral pathways that direct patients to HVCs performing both surgery and transcatheter interventions.
Trial registration number: NCT03112629.
Citation
Rudolph TK, Messika-Zeitoun D, Frey N, Lutz M, Krapf L, Passefort S, Fryearson J, Simpson H, Mortensen K, Rehse S, Tiroke A, Dodos F, Mies F, Deutsch C, Kurucova J, Thoenes M, Bramlage P, Steeds RP; IMPULSE enhanced investigators. Severe aortic stenosis management in heart valve centres compared with primary/secondary care centres. Heart. 2023 Jan 19:heartjnl-2022-321566. doi: 10.1136/heartjnl-2022-321566.
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Article