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Original research
Severe aortic stenosis management in heart valve centres compared with primary/secondary care centres
  1. Tanja K Rudolph1,
  2. David Messika-Zeitoun2,
  3. Norbert Frey3,4,
  4. Matthias Lutz3,
  5. Laura Krapf5,
  6. Stephanie Passefort6,
  7. John Fryearson7,
  8. Helen Simpson8,
  9. Kai Mortensen9,
  10. Sebastian Rehse10,
  11. Andreas Tiroke11,
  12. Fotini Dodos12,
  13. Florian Mies13,
  14. Cornelia Deutsch14,
  15. Jana Kurucova15,
  16. Martin Thoenes16,
  17. Peter Bramlage14,
  18. Richard Paul Steeds17
  19. for the IMPULSE enhanced investigators
  1. 1 Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
  2. 2 Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
  3. 3 Department of Cardiology and Angiology, University Hospital Schleswig-Holstein—Campus Kiel, Kiel, Schleswig-Holstein, Germany
  4. 4 Department of Cardiology, Angiology and Pneumology, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
  5. 5 Department of Cardiology, Hospital Max Fourestier, Nanterre, Île-de-France, France
  6. 6 Department of Cardiology, Hopital Andre Gregoire, Montreuil, Île-de-France, France
  7. 7 Department of Cardiology, South Warwickshire NHS Foundation Trust, Warwick, Warwickshire, UK
  8. 8 Birmingham Heartlands Hospital, Birmingham, West Midlands, UK
  9. 9 Kardiologische Gemeinschaftspraxis Kiel, Kiel, Germany
  10. 10 Departmet of Internal Medicine, Klinik Preetz, Preetz, Germany
  11. 11 Praxis für Kardiologie, Kiel, Germany
  12. 12 Praxis für Innere Medizin, Kardiologie, Pneumologie am Wiener Platz, Vienna, Austria
  13. 13 Kardiologische Gemeinschaftspraxis Hohenlind, Cologne, Germany
  14. 14 1Institute for Pharmacology and Preventive Medicine, IPPMed, Cloppenburg, Germany
  15. 15 Edwards Lifesciences AG Czech Republic Branch, Prague, Czech Republic
  16. 16 Edwards Lifesciences, Nyon, Switzerland
  17. 17 Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
  1. Correspondence to Dr Richard Paul Steeds, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, UK; rick.steeds{at}


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.

  • aortic stenosis
  • transcatheter aortic valve replacement
  • quality of health care

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors TKR, NF, RPS, DM-Z, JK, MT and PB were involved in the conception and design of the registry. TKR and PB drafted the manuscript and all other authors revised the article for important intellectual content. All authors gave final approval of the version to be published. RPS accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding Research grant provided by Edwards Lifesciences (Nyon, Switzerland) to the Sponsor Institute for Pharmacology and Preventive Medicine (IPPMed, Cloppenburg, Germany).

  • Competing interests IPPMed has received research funding and honoraria for consultancy from Edwards Lifesciences. JK and MT are employees of the funder. TKR, NF, ML, RPS and DM-Z received honoraria for advisory board meetings from Edwards Lifesciences. The institutions of these authors received funding for employing a study nurse. DM-Z is on the Editorial Board of BMJ Heart.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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