Facilitated Data Relay and Effects on Treatment of Severe Aortic Stenosis in Europe

J Am Heart Assoc. 2019 Oct;8(19):e013160. doi: 10.1161/JAHA.119.013160. Epub 2019 Sep 24.


Background Many patients with severe aortic stenosis are referred late with advanced symptoms or inappropriately denied intervention. The objective was to investigate whether a structured communication to referring physicians (facilitated data relay) might improve the rate and timeliness of intervention. Methods and Results A prospective registry of consecutive patients with severe aortic stenosis at 23 centers in 9 European countries with transcatheter as well as surgical aortic valve replacement being available was performed. The study included a 3-month documentation of the status quo (phase A), a 6-month intervention phase (implementing facilitated data relay), and a 3-month documentation of a legacy effect (phase-B). Two thousand one hundred seventy-one patients with severe aortic stenoses were enrolled (phase A: 759; intervention: 905; phase-B: 507). Mean age was 77.9±10.0 years, and 80% were symptomatic, including 52% with severe symptoms. During phase A, intervention was planned in 464/696 (67%), 138 (20%) were assigned to watchful waiting, 8 (1%) to balloon aortic valvuloplasty, 60 (9%) were listed as not for active treatment, and in 26 (4%), no decision was made. Three hundred sixty-three of 464 (78%) patients received the planned intervention within 3 months. Timeliness of the intervention improved as shown by the higher number of aortic valve replacements performed within 3 months (59% versus 51%, P=0.002) and a significant decrease in the time to intervention (36±38 versus 30±33 days, P=0.002). Conclusions A simple, low-cost, facilitated data relay improves timeliness of treatment for patients diagnosed with severe aortic stenosis, resulting in a shorter time to transcatheter aortic valve replacement. This effect was mainly driven by a significant improvement in timeliness of intervention in transcatheter aortic valve replacement but not surgical aortic valve replacement. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02241447.

Keywords: Quality of care; aortic stenosis; facilitated data relay; surgical aortic valve replacement; transcatheter aortic valve implantation.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis / diagnostic imaging
  • Aortic Valve Stenosis / nursing
  • Aortic Valve Stenosis / therapy*
  • Balloon Valvuloplasty* / adverse effects
  • Clinical Decision-Making
  • Cross-Sectional Studies
  • Echocardiography
  • Eligibility Determination
  • Europe
  • Female
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Humans
  • Male
  • Nurse's Role*
  • Patient Selection
  • Prospective Studies
  • Referral and Consultation*
  • Registries
  • Severity of Illness Index
  • Time Factors
  • Time-to-Treatment*
  • Transcatheter Aortic Valve Replacement* / adverse effects
  • Treatment Outcome
  • Watchful Waiting*

Associated data

  • ClinicalTrials.gov/NCT02241447