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Kumar M, Pettinato A, Ladha F, Earp JE, Jain V, Patil S, Engelman DT, Robinson PF, Moumneh MB, Goyal P, Damluji AA. Sarcopenia and aortic valve disease. Heart 2024; 110:974-979. [PMID: 38649264 PMCID: PMC11236523 DOI: 10.1136/heartjnl-2024-324029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
Valvular heart disease, including calcific or degenerative aortic stenosis (AS), is increasingly prevalent among the older adult population. Over the last few decades, treatment of severe AS has been revolutionised following the development of transcatheter aortic valve replacement (TAVR). Despite improvements in outcomes, older adults with competing comorbidities and geriatric syndromes have suboptimal quality of life outcomes, highlighting the cumulative vulnerability that persists despite valve replacement. Sarcopenia, characterised by loss of muscle strength, mass and function, affects 21%-70% of older adults with AS. Sarcopenia is an independent predictor of short-term and long-term outcomes after TAVR and should be incorporated as a prognostic marker in preprocedural planning. Early diagnosis and treatment of sarcopenia may reduce morbidity and mortality and improve quality of life following TAVR. The adverse effects of sarcopenia can be mitigated through resistance training and optimisation of nutritional status. This is most efficacious when administered before sarcopenia has progressed to advanced stages. Management should be individualised based on the patient's wishes/preferences, care goals and physical capability. Exercise during the preoperative waiting period may be safe and effective in most patients with severe AS. However, future studies are needed to establish the benefits of prehabilitation in improving quality of life outcomes after TAVR procedures.
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Affiliation(s)
| | | | - Feria Ladha
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jacob E Earp
- University of Connecticut, Storrs, Connecticut, USA
| | - Varun Jain
- Trinity Health of New England, Hartford, Connecticut, USA
| | - Shivaraj Patil
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | | | - Parag Goyal
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, USA
- Division of Cardiovascular Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Abdulla A Damluji
- Johns Hopkins University, Baltimore, Maryland, USA
- Inova Health System, Falls Church, Virginia, USA
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Mohindra R, Dobson LE, Schlosshan D, Khan P, Campbell B, Garbi M, Chambers B, Chambers JB. Heart valve service provision in the United Kingdom and the effect of the COVID 19 pandemic; improved but must do better. A British Heart Valve Society national survey. Echo Res Pract 2024; 11:11. [PMID: 38715102 PMCID: PMC11077841 DOI: 10.1186/s44156-024-00047-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Outpatient care for patients with heart valve disease (HVD) is best provided by valve clinics delivered by specialists. Modern day practice in the United Kingdom (UK) is currently poorly understood and has not been evaluated for nearly a decade. Furthermore, the COVID 19 pandemic changed the management of many chronic diseases, and how this has impacted patients with heart valve disease is unclear. METHODS A British Heart Valve Society survey was sent to 161 hospitals throughout the UK. RESULTS There was a general valve clinic in 46 of the 68 hospitals (68%), in 19 of 23 Heart Centres (83%) and 29 of 45 DGHs (64%). Across all settings, 3824 new patients and 17,980 follow up patients were seen in valve clinics per annum. The mean number of patients per hospital were 197 (median 150, range 48-550) for new patients and 532 (median 400, range 150-2000) for follow up. On the day echocardiography was available in 55% of valve clinics. In patients with severe HVD, serum brain natriuretic peptide (BNP) was measured routinely in 39% of clinics and exercise testing routinely performed in 49% of clinics. A patient helpline was available in 27% of clinics. 78% of centres with a valve clinic had a valve multidisciplinary team meeting (MDT). 45% centres had an MDT co-ordinator and MDT outcomes were recorded on a database in 64%. COVID-19 had a major impact on valve services in 54 (95%) hospitals. CONCLUSIONS There has been an increase in the number of valve clinics since 2015 from 21 to 68% but the penetration is still well short of the expected 100%, meaning that valve clinics only serve a small proportion of patients requiring surveillance for HVD. COVID-19 had a major impact on the care of patients with HVD in the majority of UK centres surveyed.
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Affiliation(s)
- R Mohindra
- Blackpool Victoria Hospital, Blackpool, UK.
| | - L E Dobson
- Manchester University Foundation Trust, Manchester, UK
| | | | - P Khan
- British Heart Valve Society, London, UK
| | - B Campbell
- Guys and St Thomas' NHS Foundation Trust, London, UK
| | - M Garbi
- Royal Papworth Hospital, Cambridge, UK
| | - B Chambers
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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3
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Jariwala P, Kulkarni GP, Punjani A, Boorugu H, Gude D. Role of Empagliflozin in heart failure with severe aortic stenosis before valve replacement: EASTER-HF study. Indian Heart J 2024; 76:207-209. [PMID: 38878965 PMCID: PMC11329009 DOI: 10.1016/j.ihj.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 03/24/2024] [Accepted: 06/12/2024] [Indexed: 06/18/2024] Open
Abstract
We evaluated empagliflozin in severe DAS patients with HF before AVR. HF patients with LVEF 30-80 % and NYHA functional class II-IV symptoms got empagliflozin 10 mg or not within 6 months before AVR, along with SOC. Adding empagliflozin to the SOC before AVR reduced HF death or HHF by 73 % after 6-months in a group of 20 patients (RR 0.27; p = 0.022). Improving LVEF (+3.48 %, p < 0.001) and NT-proBNP levels (-3974.6 pg/mL) with empagliflozin in SOC before AVR significantly reduced in-hospital and 6-month mortality in this patient group. In severe DAS and HF patients, empagliflozin improved symptoms and prognosis.
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Affiliation(s)
- Pankaj Jariwala
- Department of Cardiology, Yashoda Hospitals, Somajiguda, Raj Bhavan Road, Hyderabad, Telangana, 500082, India.
| | - Gururaj Pramod Kulkarni
- Department of Cardiology, Yashoda Hospitals, Somajiguda, Raj Bhavan Road, Hyderabad, Telangana, 500082, India.
| | - Arshad Punjani
- Department of Internal Medicine, Yashoda Hospitals, Somajiguda, Raj Bhavan Road, Hyderabad, Telangana, 500082, India.
| | - Harikishan Boorugu
- Department of Internal Medicine, Yashoda Hospitals, Somajiguda, Raj Bhavan Road, Hyderabad, Telangana, 500082, India.
| | - Dilip Gude
- Department of Internal Medicine, Yashoda Hospitals, Somajiguda, Raj Bhavan Road, Hyderabad, Telangana, 500082, India.
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4
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Rahman A, Collignon TE, Smith J. A Case Report of Sepsis Secondary to Perforated Cholecystitis in the Presence of Severe Aortic Stenosis: Diagnosis and Management. Cureus 2024; 16:e60382. [PMID: 38882954 PMCID: PMC11179744 DOI: 10.7759/cureus.60382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 05/15/2024] [Indexed: 06/18/2024] Open
Abstract
Gallbladder perforation is a rare complication of acute cholecystitis that is associated with significant morbidity and mortality. Many cases of gallbladder perforation are not diagnosed until surgery, as the physical symptoms closely mimic acute cholecystitis. Gallbladder perforation is most common among older males with associated comorbidities, and preoperative assessment of comorbidities, particularly cardiac, is critical to determine the appropriate clinical course. We report a case of a 77-year-old male who presented initially with low blood pressure and right upper quadrant pain (RUQ) after not feeling well for five days. CT of the abdomen/pelvis with IV contrast demonstrated acute perforated cholecystitis, and general surgery was consulted for a cholecystectomy. Due to the patient's past medical history of severe aortic stenosis (AS), cholecystectomy was deferred and a cholecystostomy tube was placed by interventional radiology. This report aims to provide an example of a case of perforated cholecystitis with sepsis and how it can be diagnosed and managed non-surgically in the presence of pre-existing severe AS.
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Affiliation(s)
- Austin Rahman
- Emergency Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Taylor E Collignon
- Internal Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Jason Smith
- General Surgery, AdventHealth Florida, Tavares, USA
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Miranda RN, Qiu F, Manoragavan R, Austin PC, Naimark DMJ, Fremes SE, Ko DT, Madan M, Mamas MA, Sud MK, Tam D, Wijeysundera HC. Transcatheter Aortic Valve Implantation Wait-Time Management: Derivation and Validation of the Canadian TAVI Triage Tool (CAN3T). J Am Heart Assoc 2024; 13:e033768. [PMID: 38390797 PMCID: PMC10944064 DOI: 10.1161/jaha.123.033768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/26/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has seen indication expansion and thus exponential growth in demand over the past decade. In many jurisdictions, the growing demand has outpaced capacity, increasing wait times and preprocedural adverse events. In this study, we derived prediction models that estimate the risk of adverse events on the waitlist and developed a triage tool to identify patients who should be prioritized for TAVI. METHODS AND RESULTS We included adult patients in Ontario, Canada referred for TAVI and followed up until one of the following events first occurred: death, TAVI procedure, removal from waitlist, or end of the observation period. We used subdistribution hazards models to find significant predictors for each of the following outcomes: (1) all-cause death while on the waitlist; (2) all-cause hospitalization while on the waitlist; (3) receipt of urgent TAVI; and (4) a composite outcome. The median predicted risk at 12 weeks was chosen as a threshold for a maximum acceptable risk while on the waitlist and incorporated in the triage tool to recommend individualized wait times. Of 13 128 patients, 586 died while on the waitlist, and 4343 had at least 1 hospitalization. A total of 6854 TAVIs were completed, of which 1135 were urgent procedures. We were able to create parsimonious models for each outcome that included clinically relevant predictors. CONCLUSIONS The Canadian TAVI Triage Tool (CAN3T) is a triage tool to assist clinicians in the prioritization of patients who should have timely access to TAVI. We anticipate that the CAN3T will be a valuable tool as it may improve equity in access to care, reduce preventable adverse events, and improve system efficiency.
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Affiliation(s)
- Rafael N. Miranda
- Institute of Health Policy, Management and EvaluationUniversity of TorontoCanada
| | | | - Ragavie Manoragavan
- Schulich Heart Program, Sunnybrook Health Sciences CentreUniversity of TorontoCanada
| | - Peter C. Austin
- Institute of Health Policy, Management and EvaluationUniversity of TorontoCanada
- ICESTorontoCanada
| | - David M. J. Naimark
- Institute of Health Policy, Management and EvaluationUniversity of TorontoCanada
- Temerty Faculty of MedicineUniversity of TorontoCanada
| | - Stephen E. Fremes
- Institute of Health Policy, Management and EvaluationUniversity of TorontoCanada
- ICESTorontoCanada
- Schulich Heart Program, Sunnybrook Health Sciences CentreUniversity of TorontoCanada
- Temerty Faculty of MedicineUniversity of TorontoCanada
| | - Dennis T. Ko
- ICESTorontoCanada
- Schulich Heart Program, Sunnybrook Health Sciences CentreUniversity of TorontoCanada
- Temerty Faculty of MedicineUniversity of TorontoCanada
| | - Mina Madan
- Schulich Heart Program, Sunnybrook Health Sciences CentreUniversity of TorontoCanada
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, School of MedicineKeele UniversityStoke‐on‐TrentUnited Kingdom
| | - Maneesh K. Sud
- ICESTorontoCanada
- Schulich Heart Program, Sunnybrook Health Sciences CentreUniversity of TorontoCanada
- Temerty Faculty of MedicineUniversity of TorontoCanada
| | - Derrick Tam
- Schulich Heart Program, Sunnybrook Health Sciences CentreUniversity of TorontoCanada
| | - Harindra C. Wijeysundera
- Institute of Health Policy, Management and EvaluationUniversity of TorontoCanada
- ICESTorontoCanada
- Schulich Heart Program, Sunnybrook Health Sciences CentreUniversity of TorontoCanada
- Temerty Faculty of MedicineUniversity of TorontoCanada
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Prosperi-Porta G, Nguyen V, Eltchaninoff H, Dreyfus J, Burwash IG, Willner N, Michel M, Durand E, Gilard M, Dindorf C, Iung B, Cribier A, Vahanian A, Chevreul K, Messika-Zeitoun D. Impact of the coronavirus disease 2019 pandemic on aortic valve replacement and outcomes in France. Arch Cardiovasc Dis 2024; 117:143-152. [PMID: 38267317 DOI: 10.1016/j.acvd.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND The coronavirus disease of 2019 (COVID-19) pandemic lockdowns limited access to medical care. The impact on surgical (SAVR) and transcatheter (TAVR) aortic valve replacement (AVR) has been poorly described. AIM We sought to evaluate the impact of the COVID-19 pandemic on the number and modalities of AVR, patient demographics and in-hospital outcomes at the nationwide level. METHODS Using the French nationwide administrative hospital discharge database, we compared projected numbers and proportions of AVR and hospital outcomes, obtained using linear regressions derived from 2015-2019 trends, with those observed in 2020. RESULTS In 2020, 21,382 AVRs were performed (13,051 TAVRs, 5706 isolated SAVRs and 2625 SAVRs combined with other cardiac surgery). Compared with the 2020 projected number of AVRs (24,586, 95% confidence interval [CI] 23,525-25,646), TAVRs (14,866, 95% CI 14,164-15,568), isolated SAVRs (6652, 95% CI 6203-7100) and SAVRs combined with other cardiac surgery (3069, 95% CI 2822-3315), there were reductions of 13.0%, 12.2%, 14.2% and 14.5%, respectively. These trends were similar regardless of sex or age. In 2020, the mean age, Charlson Comorbidity Index and hospital admission duration continued to decline, and the proportion of females remained constant, following 2015-2019 trends. Overall, 2020 in-hospital mortality was higher than projected (2.0% observed vs. 1.7% projected; 95% CI 1.5-1.9%), with no increased pacemaker implantation, but more acute kidney injury and cerebrovascular accidents in some surgical subsets. CONCLUSIONS During the COVID-19 pandemic, fewer TAVR and SAVR procedures were performed, with increased in-hospital mortality and periprocedural complications. Extended follow-up will be important to establish the long-term effect of the COVID-19 pandemic on patient management and outcomes.
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Affiliation(s)
- Graeme Prosperi-Porta
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Virginia Nguyen
- Cardiology Department, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | - Helene Eltchaninoff
- Department of Cardiology, CHU Rouen, Normandie University, UNIROUEN, U1096, 76000 Rouen, France
| | - Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | - Ian G Burwash
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Nadav Willner
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Morgane Michel
- Université Paris-Cité, 75006 Paris, France; Unité d'Épidémiologie Clinique, Hôpital Robert Debré, AP-HP, 75019 Paris, France; INSERM, ECEVE, U1123, 75010 Paris, France
| | - Eric Durand
- Department of Cardiology, CHU Rouen, Normandie University, UNIROUEN, U1096, 76000 Rouen, France
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, 29200 Brest, France
| | - Christel Dindorf
- Université Paris-Cité, 75006 Paris, France; INSERM, ECEVE, U1123, 75010 Paris, France; URC Eco Ile de France, Hôtel Dieu, AP-HP, 75004 Paris, France
| | - Bernard Iung
- Université Paris-Cité, 75006 Paris, France; Department of Cardiology, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Alain Cribier
- Department of Cardiology, CHU Rouen, Normandie University, UNIROUEN, U1096, 76000 Rouen, France
| | - Alec Vahanian
- Université Paris-Cité, 75006 Paris, France; INSERM U1148, Bichat Hospital, 75018 Paris, France
| | - Karine Chevreul
- Université Paris-Cité, 75006 Paris, France; Department of Cardiology, Brest University Hospital, 29200 Brest, France; URC Eco Ile de France, Hôtel Dieu, AP-HP, 75004 Paris, France
| | - David Messika-Zeitoun
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada.
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Strange JE, Nouhravesh N, Schou M, Christensen DM, Holt A, Østergaard L, Køber L, Olesen JB, Fosbøl EL. High-risk admission prior to transcatheter aortic valve replacement and subsequent outcomes. Am Heart J 2024; 268:53-60. [PMID: 37972676 DOI: 10.1016/j.ahj.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Severe, symptomatic aortic stenosis may cause heart failure, acute myocardial infarction, or syncope; limited data exist on the occurrence of such events before transcatheter aortic valve replacement (TAVR) and their impact on subsequent outcomes. Thus, we investigated the association between a preceding event and outcomes after TAVR. METHODS From 2014 to 2021 all Danish patients who underwent TAVR were included. Preceding events up to 180 days before TAVR were identified. A preceding event was defined as a hospitalization for heart failure, acute myocardial infarction, or syncope. The 1-year risk of all-cause death, and cardiovascular or all-cause hospitalization was compared for patients with versus without a preceding event using Kaplan-Meier, Aalen-Johansen, and in Cox regression analyses adjusted for patient characteristics. RESULTS Of 5,851 patients included, 759 (13.0%) had a preceding event. The median age was 81 years in both groups. Male sex and frailty were more prevalent in patients with a preceding event (males: 64.7% vs 55.2%, frailty: 49.6% vs 40.6%). The most common type of preceding event was a hospitalization for heart failure (n = 524). For patients with a preceding event, the 1-year risk of death was 11.7% (95% CI: 9.4%-14.1%) versus 8.0% (95% CI: 7.2%-8.7%) for patients without. The corresponding adjusted hazard ratio (aHR) was 1.29 (95%CI: 1.01-1.64). Mortality was highest for patients with a preceding event of a heart failure admission (1-year risk: 13.5% [95%CI: 10.5%-16.5%]). Comparing patients with a preceding event to those without, the 1-year risk for cardiovascular rehospitalization was 15.0% versus 8.2% (aHR 1.60 [95%CI: 1.29-1.99]) and 57.6% versus 50.6% for all-cause rehospitalization (aHR 1.08 [95%CI: 0.87-1.20]). CONCLUSIONS A hospitalization for heart failure, myocardial infarction, or syncope prior to TAVR was associated with a poorer prognosis and could represent a group to focus resource management on. Interventions to prevent preceding events and improvements in pre- and post-TAVR optimization of these patients are warranted.
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Affiliation(s)
- Jarl Emanuel Strange
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
| | - Nina Nouhravesh
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | | | - Anders Holt
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark; Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Lauge Østergaard
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jonas Bjerring Olesen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Emil Loldrup Fosbøl
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Mattig I, Koehler K, Barzen G, Hiddemann M, Kugel E, Roemmelt C, Mauckisch V, Vockeroth C, Stangl K, Hoppe T, Koehler F, Dreger H. Telemedical management in patients waiting for transcatheter aortic valve implantation: the ResKriVer-TAVI study design. Front Cardiovasc Med 2024; 10:1352592. [PMID: 38322273 PMCID: PMC10844945 DOI: 10.3389/fcvm.2023.1352592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 12/28/2023] [Indexed: 02/08/2024] Open
Abstract
Aims The majority of patients with severe aortic stenosis (AS) planned for transcatheter aortic valve implantation (TAVI) are elective outpatients. During the COVID-19 pandemic, the time between the heart team's decision and TAVI increased due to limited healthcare resources. We therefore implemented telemedical approaches to identify AS patients at risk for clinical deterioration during the waiting time. The purpose of the prospective, randomized, controlled ResKriVer-TAVI study (DRKS00027842) is to investigate whether a digital concept of telemedical interventional management (TIM) in AS patients waiting for TAVI improves the clinical outcomes. In the present article, we report the study protocol of the ResKriVer-TAVI trial. Methods ResKriVer-TAVI will enroll AS patients planned for elective TAVI. Randomization to the TIM group or standard care will be made on the day of the heart team's decision. TIM will include a daily assessment of weight, blood pressure, a 2-channel electrocardiogram, peripheral capillary oxygen saturation, and a self-rated health status until admission for TAVI. TIM will allow optimization of medical therapy or an earlier admission for TAVI if needed. Standard care will not include any additional support for patients with AS. All patients of the TIM group will receive a rule-based TIM including standard operating procedures when a patient is crossing prespecified values of a vital sign. Results The primary endpoint consists of days lost due to cardiovascular hospitalization and death of any cause within 180 days after the heart team's decision. Major secondary endpoints include all-cause mortality within 365 days, the number of telemedical interventions, and adherence to TIM. Follow-up visits will be conducted at admission for TAVI as well as 6 and 12 months after the heart team's decision. Conclusions ResKriVer-TAVI will be the first randomized, controlled trial investigating a telemedical approach before TAVI in patients with AS. We hypothesize that primary and secondary endpoints of AS patients with TIM will be superior to standard care. The study will serve to establish TIM in the clinical routine and to increase the resilience of TAVI centers in situations with limited healthcare resources.
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Affiliation(s)
- Isabel Mattig
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany
| | - Kerstin Koehler
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
| | - Gina Barzen
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Meike Hiddemann
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
| | - Elias Kugel
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Constantin Roemmelt
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Verena Mauckisch
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
| | - Clarissa Vockeroth
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
| | - Karl Stangl
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | | | - Friedrich Koehler
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
| | - Henryk Dreger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Virchow Klinikum, Berlin, Germany
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Stehli J, Johnston R, Duffy SJ, Zaman S, Gusberti TDH, Dagan M, Stub D, Walton A. Waiting times of women vs. men undergoing transcatheter aortic valve implantation. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:691-698. [PMID: 36460051 DOI: 10.1093/ehjqcco/qcac081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 11/08/2023]
Abstract
AIMS Increasing transcatheter aortic valve implantation (TAVI) rates have resulted in prolonged waiting times. These have been associated with heart failure hospitalizations (HFH) and mortality yet sex differences have not yet been reported. METHODS AND RESULTS All patients who underwent TAVI for severe aortic stenosis at a tertiary referral hospital in Australia were prospectively included. Total waiting time was divided into 'work-up' waiting time (period from referral date until heart team approval) and, 'procedural' waiting time (period from heart team approval until procedure date). Patients were analysed according to sex. Cohorts were matched to correct for differences in baseline and procedural variables. The primary endpoints were waiting times. Secondary outcomes included a composite of 30-day mortality and HFH, quality of life, and mobility. A total of 407 patients (42% women) were included. After matching of the two cohorts (345 patients), women had significantly longer total waiting times than men: median 156 [interquartile range (IQR) 114-220] days in women vs. 147 [IQR 92-204] days in men (P = 0.037) including longer work-up (83 [IQR 50-128] vs. 71 [IQR 36-119], P = 0.15) and procedural waiting times (65 [IQR 44-100] vs. 58 [IQR 30-93], P = 0.042). Increasing waiting times were associated with higher 30-day mortality and HFH (P = 0.01 for work-up waiting time, P = 0.02 for procedural waiting time) and decreased 30-day mobility (P = 0.044 for procedural waiting time) in women, but not in men. CONCLUSION TAVI waiting times are significantly longer in women compared to men and are associated with increased mortality and HFH and reduced mobility at 30-days.
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Affiliation(s)
- Julia Stehli
- Monash University, Faculty of Medicine, Nursing and Health Sciences, Clayton, VIC 3800, Australia
| | - Rozanne Johnston
- Department of Cardiology, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Stephen J Duffy
- Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Sarah Zaman
- Department of Cardiology, Westmead Hospital, Sydney, Westmead, NSW 2145, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, Westmead, NSW 2145, Australia
| | | | - Misha Dagan
- Department of Cardiology, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Antony Walton
- Department of Cardiology, Alfred Hospital, Melbourne, VIC 3004, Australia
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10
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Srinivasan S, Novelli A, Callas P, Gupta T, Straight F, Dauerman HL. Cardiac catheterization, coronary intervention, and wait times for transcatheter aortic valve replacement. Coron Artery Dis 2023; 34:475-482. [PMID: 37799044 DOI: 10.1097/mca.0000000000001275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVES Prolonged wait times for transcatheter aortic valve replacement (TAVR) are associated with increased morbidity and mortality. The incidence and predictors of short TAVR wait times (STWT: defined as ≤ 30 days from referral to TAVR procedure) have not been defined. This study examined the impact of clinical characteristics, demographics, and pre-TAVR cardiac catheterization on wait times for TAVR. METHODS This was a retrospective observational analysis of 831 patients with severe aortic stenosis undergoing TAVR from 2019 to mid-2022 at the University of Vermont Medical Center. Demographics, timing of treatment [stratified by COVID-19 onset (1 March 2020)], TAVR center travel distance, baseline clinical factors, and process-related variables were analyzed to determine univariate STWT predictors (P < 0.10). Multivariable analysis was performed to determine independent STWT predictors. RESULTS Approximately 50% of TAVR patients in this study achieved a STWT. The proportion of patients with STWT was higher (54.7% vs. 45.2%; P = 0.008) after the onset of COVID-19 pandemic. STWT was not related to travel distance (P = 0.61). Patients with left ventricular ejection fraction (LVEF) > 60% were less likely to achieve STWT compared to patients with LVEF < 40% (OR 0.45, P = 0.003). Patients who required catheterization or percutaneous coronary intervention (PCI) before TAVR were significantly less likely to achieve STWT (OR 0.65, P = 0.01). CONCLUSION TAVR wait times were not affected by the COVID-19 pandemic or single rural TAVR center travel distance. Sicker patients were more likely to achieve STWT while catheterization/PCI before TAVR was associated with longer wait times.
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Affiliation(s)
| | - Alexandra Novelli
- Department of Medicine, University of Vermont Larner College of Medicine
| | - Peter Callas
- Division of Cardiology, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Tanush Gupta
- Department of Medicine, University of Vermont Larner College of Medicine
- Division of Cardiology, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Faye Straight
- Division of Cardiology, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Harold L Dauerman
- Department of Medicine, University of Vermont Larner College of Medicine
- Division of Cardiology, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
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11
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Ryffel C, Alaour B, Tomii D, Okuno T, Temperli F, Bruno J, Ruberti A, Demirel C, Lanz J, Praz F, Stortecky S, Reineke D, Windecker S, Heg D, Pilgrim T. Impact of COVID-19 Surge Periods on Clinical Outcomes of Transcatheter Aortic Valve Implantation. Am J Cardiol 2023; 204:32-39. [PMID: 37536202 DOI: 10.1016/j.amjcard.2023.07.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023]
Abstract
Healthcare systems adopted various strategies to minimize the impact of the COVID-19 pandemic on clinical outcomes of patients with symptomatic severe aortic stenosis referred for transcatheter aortic valve implantation (TAVI). We aimed to compare baseline characteristics and procedural and clinical outcomes of patients who underwent TAVI during COVID-19 surge periods with those of patients who underwent TAVI during the nonsurge and prepandemic periods. In the prospective Bern TAVI registry, the pandemic period was divided into surge and nonsurge periods on the basis of the mean number of occupied beds in the intensive care unit in each month and matched with 11 months immediately preceding the pandemic. A total of 1,069 patients underwent TAVI between April 1, 2019 and December 31, 2021. Patients who underwent TAVI during surge periods had a higher surgical risk (Society of Thoracic Surgeons predicted risk of mortality) than that of patients who underwent TAVI during nonsurge and prepandemic periods. Diagnosis-to-procedure time (in days) was longer for patients who underwent TAVI during the surge period than during the nonsurge and prepandemic periods (95.20 ± 121.07 vs 70.99 ± 72.25 and 60.46 ± 75.43, both p <0.001). At 30 days, all-cause mortality was higher in the surge than in the nonsurge group (4.9 vs 1.1%, hazard ratio 4.68, 95% confidence interval 1.55 to 14.10, p = 0.006), and in the surge than in the prepandemic group (4.9 vs 1.3%, hazard ratio 3.67, 95% confidence interval 1.34 to 10.11, p = 0.012). In conclusion, TAVI during COVID-19 surge periods was associated with higher Society of Thoracic Surgeons predicted risk of mortality score, delayed procedure scheduling, and increased 30-day mortality than that of TAVI during nonsurge and prepandemic periods.
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Affiliation(s)
| | | | | | - Taishi Okuno
- Department of Cardiology, Bern University Hospital
| | | | - Jolie Bruno
- Department of Cardiology, Bern University Hospital
| | | | | | - Jonas Lanz
- Department of Cardiology, Bern University Hospital
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital
| | | | - David Reineke
- Department of Cardiac Surgery, Inselspital, Bern University Hospital
| | | | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
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12
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Zamorano JL, Appleby C, Benamer H, Frankenstein L, Musumeci G, Nombela-Franco L. Improving access to transcatheter aortic valve implantation across Europe by restructuring cardiovascular services: An expert council consensus statement. Catheter Cardiovasc Interv 2023; 102:547-557. [PMID: 37431253 DOI: 10.1002/ccd.30760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/01/2023] [Accepted: 06/28/2023] [Indexed: 07/12/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is recommended for a growing range of patients with severe aortic stenosis in the European Society of Cardiology and European Association for Cardio-Thoracic Surgery (ESC/EACTS) 2021 Guidelines update. However, guideline implementation programs are needed to ensure the application of clinical recommendations which will favorably influence disease outcomes. An Expert Council was convened to identify whether cardiology services across Europe are set up to address the growing needs of patients with severe aortic stenosis for increased access to TAVI by identifying the key challenges faced in growing TAVI programs and mapping associated solutions. Wide variation exists across Europe in terms of TAVI availability and capacity to deliver the increased demand for TAVI in different countries. The recommendations of this Expert Council focus on the short-to-medium-term aspects where the most immediate, actionable impact can be achieved. The focus on improving procedural efficiency and optimizing the patient pathway via clinical practice and patient management demonstrates how to mitigate the current major issues of shortfall in catheterization laboratory, workforce, and bed capacity. Procedural efficiencies may be achieved through steps including streamlined patient assessment, the benchmarking of standards for minimalist procedures, standardized approaches around patient monitoring and conduction issues, and the implementation of nurse specialists and dedicated TAVI coordinators to manage organization, logistics, and early mobilization. Increased collaboration with wider stakeholders within institutions will support successful TAVI uptake and improve patient and economic outcomes. Further, increased education, collaboration, and partnership between cardiology centers will facilitate sharing of expertise and best clinical practice.
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Affiliation(s)
- José Luis Zamorano
- Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain
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13
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Iung B, Pierard L, Magne J, Messika-Zeitoun D, Pibarot P, Baumgartner H. Great debate: all patients with asymptomatic severe aortic stenosis need valve replacement. Eur Heart J 2023; 44:3136-3148. [PMID: 37503668 DOI: 10.1093/eurheartj/ehad355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Affiliation(s)
- Bernard Iung
- Cardiology Department, Bichat Hospital, APHP, Université Paris Cité, 46 rue Henri Huchard, 75018 Paris, France
| | - Luc Pierard
- Department of Cardiology, University of Liege, Avenue de l´Hopital, 11, B-4000 Liege, Belgium
| | - Julien Magne
- Inserm U1094, IRD U270, University Limoges, CHU Limoges, EpiMaCT-Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, Omega Health, 2 rue du Dr Marcland, 87025 Limoges, France
- CHU Limoges, Centre of Research and Clinical Data, 2 rue Martin Luther King, 87402 Limoges, France
| | - David Messika-Zeitoun
- Division of Cardiology, University of Ottawa Heart Institute, 40, Rue Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Philippe Pibarot
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, 2725, Chemin Saite-Foy, Quebec City, Quebec G1V 4G5, Canada
| | - Helmut Baumgartner
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
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14
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Rosseel L, Mylotte D, Cosyns B, Vanhaverbeke M, Zweiker D, Teles RC, Angerås O, Neylon A, Rudolph TK, Wykrzykowska JJ, Patterson T, Costa G, Ojeda S, Tzikas A, Abras M, Leroux L, Van Belle E, Tchétché D, Bleiziffer S, Swaans MJ, Parma R, Blackman DJ, Van Mieghem NM, Grygier M, Redwood S, Prendergast B, Van Camp G, De Backer O. Contemporary European practice in transcatheter aortic valve implantation: results from the 2022 European TAVI Pathway Registry. Front Cardiovasc Med 2023; 10:1227217. [PMID: 37645516 PMCID: PMC10461475 DOI: 10.3389/fcvm.2023.1227217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Background A steep rise in the use of transcatheter aortic valve implantation (TAVI) for the management of symptomatic severe aortic stenosis occurred. Minimalist TAVI procedures and streamlined patient pathways within experienced Heart Valve Centres are designed to overcome the challenges of ever-increasing procedural volume. Aims The 2022 European TAVI Pathway Survey aims to describe contemporary TAVI practice across Europe. Materials and methods Between October and December 2022, TAVI operators from 32 European countries were invited to complete an online questionnaire regarding their current practice. Results Responses were available from 147 TAVI centres in 26 countries. In 2021, the participating centres performed a total number of 27,223 TAVI procedures, with a mean of 185 TAVI cases per centre (median 138; IQR 77-194). Treatment strategies are usually (87%) discussed at a dedicated Heart Team meeting. Transfemoral TAVI is performed with local anaesthesia only (33%), with associated conscious sedation (60%), or under general anaesthesia (7%). Primary vascular access is percutaneous transfemoral (99%) with secondary radial access (52%). After uncomplicated TAVI, patients are transferred to a high-, medium-, or low-care unit in 28%, 52%, and 20% of cases, respectively. Time to discharge is day 1 (12%), day 2 (31%), day 3 (29%), or day 4 or more (28%). Conclusion Reported adoption of minimalist TAVI techniques is common among European TAVI centres, but rates of next-day discharge remain low. This survey highlights the significant progress made in refining TAVI treatment and pathways in recent years and identifies possible areas for further improvement.
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Affiliation(s)
- Liesbeth Rosseel
- Department of Cardiology, Algemeen Stedelijk Hospital, Aalst, Belgium
- Faculteit Geneeskunde, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway and National University of Ireland, Galway, Ireland
| | - Bernard Cosyns
- Faculteit Geneeskunde, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Centrum Voor Hart- en Vaatziekten (CHVZ), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | | | - David Zweiker
- Division of Cardiology, Department of Cardiology and Intensive Care, Clinic Ottakring, Medical University of Graz, Graz, Austria
| | - Rui Campante Teles
- Centro Hospitalar de Lisboa Ocidental (CHLO), Hospital de Santa Cruz
- Nova Medical School, Centro de Estudo de Doenças Crónicas (CEDOC), Lisbon, Portugal
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenberg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | | | - Tanja Katharina Rudolph
- Clinic of General and Interventional Cardiology, Heart and Diabetes Center Nordrhine Westfalia, Ruhr-University, Bad Oeynhausen, Germany
| | | | - Tiffany Patterson
- Department of Cardiology, Guys and St Thomas’ NHS Foundation Trust London, London, United Kingdom
| | - Giulia Costa
- Cardiac Catheterization Division, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Soledad Ojeda
- Division of Interventional Cardiology, Reina Sofia Hospital, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIV), University of Córdoba, Córdoba, Spain
| | - Apostolos Tzikas
- Department of Cardiology, European Interbalkan Medical Centre, Thessaloniki, Greece
| | - Marcel Abras
- University Clinic of Interventional Cardiology, Nicolae Testemitanu State University of Medicine and Pharmacy from Republic of Moldova, Chişinău, Moldova
| | - Lionel Leroux
- Medico-Surgical Department of Valvulopathies, CHU De Bordaux, Pessac, France
| | - Eric Van Belle
- CHU Lille, Institut Cœur Poumon, Pôle Cardiovasculaire et Pulmonaire, ACTION Group, Inserm U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France
| | - Didier Tchétché
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Sabine Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Martin J. Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Radoslaw Parma
- Department of Cardiology and Structural Heart Diseases, 3 Division of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Daniel J. Blackman
- Department of Cardiology, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Nicolas M. Van Mieghem
- Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marek Grygier
- Chair and 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Simon Redwood
- Department of Cardiology, Guys and St Thomas’ NHS Foundation Trust London, London, United Kingdom
| | - Bernard Prendergast
- Department of Cardiology, Guys and St Thomas’ NHS Foundation Trust London, London, United Kingdom
| | - Guy Van Camp
- Department of Cardiology, Heart Center OLV Aalst, Aalst, Belgium
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15
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Lauck SB, Yu M, Pu A, Virani S, Meier D, Akodad M, Sathananthan J, Chan AW, Price J, Wong D, Wood DA, Webb JG, Abel JG. Temporal Changes in Quality Indicators in a Regional System of Care After Surgical and Transcatheter Aortic Valve Replacement. CJC Open 2023; 5:508-521. [PMID: 37496781 PMCID: PMC10366640 DOI: 10.1016/j.cjco.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 07/28/2023] Open
Abstract
Background Historically, quality-of-care monitoring was performed separately for transcatheter and surgical aortic valve replacement (TAVR, SAVR). Using consensus indicators, we provide a global report on the quality of care for treatment of aortic stenosis across the highest-volume treatments: transfemoral (TF) TAVR, isolated SAVR, and SAVR combined with coronary artery bypass graft. Methods Retrospective observational cohort study of consecutive patients in a regional system of care. Primary endpoint was 30-day and 1-year mortality (2015-2019). Secondary endpoints included rate of new pacemaker, rate of readmission, and length of stay (2012-2019). Following multivariable logistic regressions, we developed mortality case-mix adjustment models to report risk estimates. Results The proportion of patients receiving TAVR grew from 32% to 53% (2015-2019). Those receiving TF TAVR were significantly older, with higher rates of comorbidities. Observed 30-day and 1-year all-cause mortality after TF TAVR decreased from 3.1% to 0.6% (P = 0.03), and 13.6% to 6.6% (P = 0.09), respectively; surgical mortality rates for isolated SAVR and SAVR combined with coronary artery bypass graft were low and did not change significantly over time, ranging from 0.3% to 1.4% and from 0.9% to 3.4%, respectively at 30 days, and from 0.9% to 3.4% and from 4.7% to 6.7 at 1 year. In the TF TAVR cohort, the observed vs expected ratio for 30-day and 1-year mortality decreased significantly from 1.9 (95% confidence interval [CI] 0.9, 3.5) to 0.3 (95% CI 0.1, 0.8), and from 1.3 (95% CI 0.9, 1.7) to 0.7 (95% CI 0.5, 0.99), respectively; no change occurred in risk-adjusted surgical mortality. Conclusions Consensus quality indicators provide unique insights on the quality of care for patients receiving treatment for aortic stenosis.
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Affiliation(s)
- Sandra B. Lauck
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Maggie Yu
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Aihua Pu
- Cardiac Services BC, Vancouver, British Columbia, Canada
| | - Sean Virani
- Cardiac Services BC, Vancouver, British Columbia, Canada
| | - David Meier
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mariam Akodad
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques-Cartier, Ramsay Santé, Massy, France
| | - Janarthanan Sathananthan
- University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Albert W. Chan
- Division of Cardiology, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Joel Price
- Division of Cardiovascular and Thoracic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Wong
- Department of Cardiac Surgery, Royal Columbian Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A. Wood
- University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G. Webb
- University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - James G. Abel
- University of British Columbia, Vancouver, British Columbia, Canada
- Division of Cardiovascular and Thoracic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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16
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Wijeysundera HC, Gaudino M, Qiu F, Olson MA, Mao J, Manoragavan R, Rong L, Tam DY, Austin PC, Fremes SE, Sedrakyan A. Regional Differences in Outcomes for Patients Undergoing Transcatheter Aortic Valve Replacement in New York State and Ontario. Can J Cardiol 2023; 39:570-577. [PMID: 36737001 PMCID: PMC11116973 DOI: 10.1016/j.cjca.2023.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/27/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has become the standard of care for a wide spectrum of patients with severe aortic stenosis. However, there are wide variations in access to TAVR among jurisdictions. It is unknown if such variation is associated with differences in postprocedural outcomes. Our objective was to determine whether differences in health care delivery in jurisdictions with high vs low access of care to TAVR translate to differences in postprocedural outcomes. METHODS In this observational, retrospective cohort study, we identified all Ontario and New York State residents greater than 18 years of age who received TAVR from January 1, 2012, to December 31, 2018. Our primary outcomes were post-TAVR 30 day in-hospital mortality and all-cause readmissions. Using indirect standardization, we calculated the observed vs expected outcomes for New York patients, had they been treated in Ontario. RESULTS Our cohort consisted of 16,814 TAVR patients at 36 hospitals in New York State and 5007 TAVR patients at 11 hospitals in Ontario. In Ontario, TAVR access rates increased from ∼18.2 TAVR per million in 2012 to 87.4 TAVR per million in 2018, whereas for New York State, the rates increased from 31.9 to 220.4 TAVR per million. For 30-day mortality, 3.1% of Ontario TAVR patients had an in-hospital death, compared with 2.5% of New York patients. With adjustment, this translated to an observed-expected ratio of 0.70 (95% confidence interval [CI], 0.54-0.92) for New York patients. CONCLUSIONS Having greater access to TAVR may be associated with improved outcomes, potentially because of intervention earlier in the trajectory of the disease.
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Affiliation(s)
- Harindra C Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Feng Qiu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Molly A Olson
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Jialin Mao
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Ragavie Manoragavan
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Derrick Y Tam
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter C Austin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Art Sedrakyan
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
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Raisi-Estabragh Z, Mamas MA. Cardiovascular Health Care Implications of the COVID-19 pandemic. Heart Fail Clin 2023; 19:265-272. [PMID: 36863818 PMCID: PMC9973542 DOI: 10.1016/j.hfc.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has challenged the capacity of health care systems around the world, including substantial disruptions to cardiovascular care across key areas of health care delivery. In this narrative review, we examine the implications of the COVID-19 pandemic for cardiovascular health care, including excess cardiovascular mortality, acute and elective cardiovascular care, and disease prevention. Additionally, we consider the long-term public health consequences of disruptions to cardiovascular care across both primary and secondary care settings. Finally, we review health care inequalities and their driving factors, as highlighted by the pandemic, and consider their importance in the context of cardiovascular health care.
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Affiliation(s)
- Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University, London EC1M 6BQ, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele ST5 5BG, United Kingdom; Department of Cardiology, Thomas Jefferson University, Philadelphia, PA 19107, USA; Institute of Population Health, University of Manchester, Manchester M13 9PT, United kingdom.
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Noble S, Mauler-Wittwer S, Poku NK. Geographic Determinants of Outcomes After TAVR: Should We Favour Timely Access to TAVR Rather Than High Volume Per Centre? Can J Cardiol 2023; 39:578-580. [PMID: 37173056 DOI: 10.1016/j.cjca.2023.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 03/29/2023] Open
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Baron SJ, Berry N. Editorial: Extending the Minimalist Approach to the Pre-Transcatheter Aortic Valve Replacement Coronary Evaluation. STRUCTURAL HEART 2022. [DOI: 10.1016/j.shj.2022.100131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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20
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Hanna G, Macdonald D, Bittira B, Horlick E, Ali N, Atoui R, Alqahtani A, Fam N, Shurrab M, Spadafore J, Allen J, Cheema A, Nalla B, Pulkkinen C, Cote S, Hennessey H, Stringer M, Leblanc S, Collin J, Fenton J, Rheault-Henry M, Lauck S, Sathananthan J, Wood D, Alnasser S. The Safety of Early Discharge Following Transcatheter Aortic Valve Implantation Among Patients in Northern Ontario and Rural Areas Utilizing the Vancouver 3M TAVI Study Clinical Pathway. CJC Open 2022; 4:1053-1059. [PMID: 36562010 PMCID: PMC9764127 DOI: 10.1016/j.cjco.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/09/2022] [Indexed: 12/25/2022] Open
Abstract
Background Early hospital ( < 48 hours) discharge following transcatheter aortic valve implantation (TAVI) is an increasingly adopted practice; however, data on the safety of such an approach among patients residing in North Ontario, including remote and medically underserved areas, are lacking. Methods This retrospective study included patients who underwent TAVI in Sudbury, Ontario. The safety of early discharge after implementation of the Vancouver 3M (multidisciplinary, multimodality, but minimalist) clinical pathway was assessed. The primary endpoint was 30-day mortality. Resource utilization before vs after 3M clinical pathway implementation was also compared. Results A total of 291 patients who underwent TAVI between 2012 and 2021 were included in the study. One in-hospital death (0.6%) occurred after the 3M clinical pathway implementation, with no mortality observed beyond hospital discharge. Eleven patients (6.7%) required rehospitalization within 30 days. The need for mechanical ventilation and surgical vascular cut-down declined from 100% and 97%, respectively, at baseline, to 6% and 2%. The number of patients receiving TAVI on a given procedural day increased from 2 to 3 patients. The median post-TAVI hospital length of stay decreased from 5 days (2-6 days) to 1 day (1-3 days) after 3M clinical pathway implementation. Conclusions Following TAVI, early discharge of selected patients residing in Northern Ontario, including rural areas, using the Vancouver 3M clinical pathway was associated with favourable outcomes, short length of stay, and more-efficient resource utilization. These data can help improve healthcare efficiency and bridge variations in TAVI funding and accessibility in underserved locations.
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Affiliation(s)
- George Hanna
- Department of Cardiology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Derek Macdonald
- Division of Cardiac Surgery, Health Sciences North, Sudbury, Ontario, Canada
| | - Bindu Bittira
- Division of Cardiac Surgery, Health Sciences North, Sudbury, Ontario, Canada
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Eric Horlick
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Noman Ali
- Department of Cardiology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rony Atoui
- Division of Cardiac Surgery, Health Sciences North, Sudbury, Ontario, Canada
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | | | - Neil Fam
- Department of Cardiology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed Shurrab
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
- Division of Cardiology, Health Sciences North, Sudbury, Ontario, Canada
| | - Joanne Spadafore
- Division of Cardiology, Health Sciences North, Sudbury, Ontario, Canada
| | - Julie Allen
- Division of Cardiology, Health Sciences North, Sudbury, Ontario, Canada
| | - Asim Cheema
- Southlake Regional Health Center, Newmarket, Ontario, Canada
| | - Bhanu Nalla
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
- Division of Anaesthesia, Health Sciences North, Sudbury, Ontario, Canada
| | - Carly Pulkkinen
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
- Division of Anaesthesia, Health Sciences North, Sudbury, Ontario, Canada
| | - Sylvain Cote
- Division of Anaesthesia, Health Sciences North, Sudbury, Ontario, Canada
| | - Hooman Hennessey
- Division of Radiology, Health Sciences North, Sudbury, Ontario, Canada
| | - Melissa Stringer
- Division of Cardiology, Health Sciences North, Sudbury, Ontario, Canada
| | - Suzanne Leblanc
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
- Division of Cardiology, Health Sciences North, Sudbury, Ontario, Canada
| | - Joanne Collin
- Division of Cardiology, Health Sciences North, Sudbury, Ontario, Canada
| | - John Fenton
- Division of Vascular Surgery, Health Sciences North, Sudbury, Ontario, Canada
| | | | - Sandra Lauck
- University of British Colombia Innovation Centre, Vancouver, British Colombia, Canada
| | | | - David Wood
- University of British Colombia Innovation Centre, Vancouver, British Colombia, Canada
| | - Sami Alnasser
- Department of Cardiology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- Corresponding author: Dr Sami Alnasser, St. Michael’s Hospital—7th Fl, Donnelly Wing, 30 Bond St., Toronto, Ontario M5B 1W8, Canada. Tel.: +1-416-864-5905; fax: +1-416-864-5566.
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21
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Peel JK, Neves Miranda R, Naimark D, Woodward G, Mamas MA, Madan M, Wijeysundera HC. Financial Incentives for Transcatheter Aortic Valve Implantation in Ontario, Canada: A Cost-Utility Analysis. J Am Heart Assoc 2022; 11:e025085. [PMID: 35411786 PMCID: PMC9238449 DOI: 10.1161/jaha.121.025085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Transcatheter aortic valve implantation (TAVI) is a minimally invasive therapy for patients with severe aortic stenosis, which has become standard of care. The objective of this study was to determine the maximum cost‐effective investment in TAVI care that should be made at a health system level to meet quality indicator goals. Methods and Results We performed a cost‐utility analysis using probabilistic patient‐level simulation of TAVI care from the Ontario, Canada, Ministry of Health perspective. Costs and health utilities were accrued over a 2‐year time horizon. We created 4 hypothetical strategies that represented TAVI care meeting ≥1 quality indicator targets, (1) reduced wait times, (2) reduced hospital length of stay, (3) reduced pacemaker use, and (4) combined strategy, and compared these with current TAVI care. Per‐person costs, quality‐adjusted life years, and clinical outcomes were estimated by the model. Using these, incremental net monetary benefits were calculated for each strategy at different cost‐effectiveness thresholds between $0 and $100 000 per quality‐adjusted life year. Clinical improvements over the current practice were estimated with all comparator strategies. In Ontario, achieving quality indicator benchmarks could avoid ≈26 wait‐list deaths and 200 wait‐list hospitalizations annually. Compared with current TAVI care, the incremental net monetary benefit for this strategy varied from $10 765 (±$8721) and $17 221 (±$8977). This would translate to an annual investment of between ≈$14 to ≈$22 million by the Ontario Ministry of Health to incentivize these performance measures being cost‐effective. Conclusions This study has quantified the modest annual investment required and substantial clinical benefit of meeting improvement goals in TAVI care.
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Affiliation(s)
- John K Peel
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto Ontario Canada.,Department of Anesthesiology and Pain Medicine University of Toronto Ontario Canada.,Toronto Health Economics and Technology Assessment Collaborative Toronto Ontario Canada
| | - Rafael Neves Miranda
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto Ontario Canada.,Toronto Health Economics and Technology Assessment Collaborative Toronto Ontario Canada
| | - David Naimark
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto Ontario Canada.,Toronto Health Economics and Technology Assessment Collaborative Toronto Ontario Canada.,Sunnybrook Research InstituteSunnybrook Health Sciences Centre Toronto Ontario Canada.,Department of Medicine University of Toronto Ontario Canada
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group Keele University Keele United Kingdom
| | - Mina Madan
- Sunnybrook Research InstituteSunnybrook Health Sciences Centre Toronto Ontario Canada.,Department of Medicine University of Toronto Ontario Canada
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto Ontario Canada.,Toronto Health Economics and Technology Assessment Collaborative Toronto Ontario Canada.,Sunnybrook Research InstituteSunnybrook Health Sciences Centre Toronto Ontario Canada.,Department of Medicine University of Toronto Ontario Canada
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Roule V, Rebouh I, Lemaitre A, Sabatier R, Blanchart K, Briet C, Bignon M, Beygui F. Impact of wait times on late postprocedural mortality after successful transcatheter aortic valve replacement. Sci Rep 2022; 12:5967. [PMID: 35395869 PMCID: PMC8993919 DOI: 10.1038/s41598-022-09995-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 03/21/2022] [Indexed: 11/30/2022] Open
Abstract
Wait times are associated with mortality on waiting list for transcatheter aortic valve replacement (TAVR). Whether longer wait times are associated with long term mortality after successful TAVR remains unassessed. Consecutive patients successfully treated with elective TAVR in our center between January 2013 and August 2019 were included. The primary end point was one-year all-cause mortality. TAVR wait times were defined as the interval from referral date for valve replacement to the date of TAVR procedure. A total of 383 patients were included with a mean wait time of 144.2 ± 83.87 days. Death occurred in 55 patients (14.4%) at one year. Increased wait times were independently associated with a relative increase of 1-year mortality by 2% per week after referral (Adjusted Hazard Ratio 1.02 [1.002–1.04]; p = 0.02) for TAVR. Chronic kidney disease, left ventricular ejection fraction ≤ 30%, access site and STS score were other independent correlates of 1-year mortality. Our study shows that wait times are relatively long in routine practice and associated with increased 1-year mortality after successful TAVR. Such findings underscore the need of strategies to minimize delays in access to TAVR.
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Affiliation(s)
- Vincent Roule
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France. .,INSERM UMRS 1237, GIP Cyceron, 14000, Caen, France. .,Cardiology Department, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France.
| | - Idir Rebouh
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | - Adrien Lemaitre
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | - Rémi Sabatier
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | | | - Clément Briet
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | - Mathieu Bignon
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | - Farzin Beygui
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France.,INSERM UMRS 1237, GIP Cyceron, 14000, Caen, France.,ACTION Study Group, Cardiology Department, Pitié-Salpêtrière University Hospital, Paris, France
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Baumgartner H, Iung B, Messika-Zeitoun D, Otto CM. The year in cardiovascular medicine 2021: valvular heart disease. Eur Heart J 2022; 43:633-640. [PMID: 34974619 DOI: 10.1093/eurheartj/ehab885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/15/2021] [Accepted: 12/23/2021] [Indexed: 12/27/2022] Open
Affiliation(s)
- Helmut Baumgartner
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, Muenster 48149, Germany
| | - Bernard Iung
- Department of Cardiology, Bichat Hospital, APHP, Université de Paris, Paris, France
| | | | - Catherine M Otto
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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25
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Kobo O, Saada M, Roguin A. Can transcatheter aortic valve implantation [TAVI] be performed at institutions without on-site cardiac surgery department? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 41:159-165. [PMID: 34953737 DOI: 10.1016/j.carrev.2021.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/20/2021] [Accepted: 12/09/2021] [Indexed: 11/03/2022]
Abstract
Transcatheter aortic valve implantation [TAVI] represents a paradigm shift in therapeutic options for patients with severe aortic stenosis [AS]. In less than 20 years, TAVI has rapidly disseminated to include a significant proportion of AS patients. The number of AS patients needing TAVI is expected to further increase. Since there is a limited number of centers performing TAVI, wait times are expected to increase. This might have a critical impact of AS patient life as mortality rate of AS patients awaiting TAVI, is substantial, ranging from 2 to 10%. With time, as more patients were treated, improved experience, better imaging and devices, this technology became safer with more reliable results. Today most TAVI complications are related to vascular access [4-6%] and there is less need for emergency thoracic bail out [0.2-0.5%]. In this review, we summarize the prognosis while waiting, the outcomes of patients undergoing TAVI at institutions without on-site cardiac surgery departments and the data describing rates and outcomes of TAVI patients requiring treatment of intra-procedural life-threatening complications. Similar to coronary interventions in the past, TAVI should be considered also in centers without on-site cardiac surgery departments under certain conditions such as, experienced operators, heart team discussion, well established imaging modalities, skilled and qualified support personal, and adequate pre- and post-care facility.
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Affiliation(s)
- Ofer Kobo
- Hillel Yaffe Medical Center, Technion - Israel Institute of Technology, Haifa, Israel
| | - Majdi Saada
- Hillel Yaffe Medical Center, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ariel Roguin
- Hillel Yaffe Medical Center, Technion - Israel Institute of Technology, Haifa, Israel.
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Deferred versus Expedited Aortic Valve Replacement in Patients with Symptomatic Severe Aortic Stenosis During the SARS-CoV-2 Pandemic (AS DEFER): A Research Letter. Glob Heart 2021; 16:32. [PMID: 34040945 PMCID: PMC8086732 DOI: 10.5334/gh.989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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27
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Sherwood MW, Vora AN. Is Transcatheter Aortic Valve Replacement Worth the Wait? Circ Cardiovasc Interv 2020; 13:e010138. [PMID: 33167703 DOI: 10.1161/circinterventions.120.010138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew W Sherwood
- Department of Cardiology, Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
- Duke Clinical Research Institute, Durham, NC (M.W.S.)
| | - Amit N Vora
- Department of Cardiology, University of Pittsburg Medical Center-Pinnacle Health System, Harrisburg, PA (A.N.V.)
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