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Severe aortic stenosis and the need for the right treatment, in the right place, at the right time
  1. Zulfiqar Ali,
  2. Aidan W Flynn
  1. Cardiology, Health Service Executive Saolta University Hospital Group, Ballinasloe, Ireland
  1. Correspondence to Dr Aidan W Flynn, Cardiology, Health Service Executive Saolta University Hospital Group, Ballinasloe 98195, Ireland; aidan.flynn{at}

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Severe symptomatic aortic stenosis (AS) is a class I indication for aortic valve replacement (AVR), and AVR should be performed in a timely manner,1 acknowledging such caveats as other life-limiting conditions and patient preference/consent. Similarly, ST segment elevation myocardial infarction (STEMI) is a class I indication for primary percutaneous coronary intervention (PCI) and should be performed in a time-sensitive manner,2 again acknowledging the aforementioned caveats. Hospital networks are designed such that there are ‘PCI-capable’ and ‘non-PCI-capable’ centres, and an important metric of the performance of a hospital network is the percentage of patients with STEMI receiving timely intervention when presenting to a non-PCI-capable centre. Although STEMI and severe AS differ in the time frame of needing to treat, it is reasonable to assess the performance of a hospital network by the percentage of symptomatic patients with severe AS undergoing AVR, by whatever means, in a timely fashion.

While the intervention will be performed in the ‘AVR-capable’ centre, inevitably many patients (perhaps the majority) will be either initially referred to a hospital or clinic with no onsite AVR capability or will be detected as having severe symptomatic AS de novo while an inpatient in such a facility. Our systems should facilitate equitable and timely access to AVR for all patients identified as having severe symptomatic AS, regardless of their diagnostic journey.

This leads us to the present study by Rudolph et al.3 It describes …

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  • Contributors Both authors contributed equally to this editorial.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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