RT Journal Article
SR Electronic
T1 Severe aortic stenosis management in heart valve centres compared with primary/secondary care centres
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP heartjnl-2022-321566
DO 10.1136/heartjnl-2022-321566
A1 Tanja K Rudolph
A1 David Messika-Zeitoun
A1 Norbert Frey
A1 Matthias Lutz
A1 Laura Krapf
A1 Stephanie Passefort
A1 John Fryearson
A1 Helen Simpson
A1 Kai Mortensen
A1 Sebastian Rehse
A1 Andreas Tiroke
A1 Fotini Dodos
A1 Florian Mies
A1 Cornelia Deutsch
A1 Jana Kurucova
A1 Martin Thoenes
A1 Peter Bramlage
A1 Richard Paul Steeds
A1 ,
YR 2023
UL http://heart.bmj.com/content/early/2023/01/18/heartjnl-2022-321566.abstract
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.