PT  - JOURNAL ARTICLE
AU  - Rudolph, Tanja K
AU  - Messika-Zeitoun, David
AU  - Frey, Norbert
AU  - Lutz, Matthias
AU  - Krapf, Laura
AU  - Passefort, Stephanie
AU  - Fryearson, John
AU  - Simpson, Helen
AU  - Mortensen, Kai
AU  - Rehse, Sebastian
AU  - Tiroke, Andreas
AU  - Dodos, Fotini
AU  - Mies, Florian
AU  - Deutsch, Cornelia
AU  - Kurucova, Jana
AU  - Thoenes, Martin
AU  - Bramlage, Peter
AU  - Steeds, Richard Paul
ED  - ,
TI  - Severe aortic stenosis management in heart valve centres compared with primary/secondary care centres
AID  - 10.1136/heartjnl-2022-321566
DP  - 2023 Jan 18
TA  - Heart
PG  - heartjnl-2022-321566
4099  - http://heart.bmj.com/content/early/2023/01/18/heartjnl-2022-321566.short
4100  - http://heart.bmj.com/content/early/2023/01/18/heartjnl-2022-321566.full
AB  - 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.Data are available on reasonable request.