Time to TAVI: streamlining the pathway to treatment

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Health Services Research

Background:

• Severe aortic stenosis poses significant morbidity and mortality risks.
• Traditional transcatheter aortic valve implantation (TAVI) pathways rely on tertiary Heart Valve Centres, often causing treatment delays.
• Existing delays breach British Cardiovascular Intervention Society targets, necessitating pathway optimization.

Purpose of the Study:

• To evaluate a novel TAVI referral pathway emphasizing local comprehensive patient workup.
• To assess the impact of this new pathway on time to TAVI and referral acceptance rates.
• To determine if local workup improves TAVI accessibility.

Main Methods:

• Retrospective data collection of TAVI referrals from November 2020 to November 2021.
• Comparison of time from referral to TAVI between a center with a novel local workup pathway and traditional pathways.
• Analysis of total pathway time (echocardiographic diagnosis to TAVI) for the novel pathway.
• Secondary analysis of referral acceptance rates for TAVI.

Main Results:

• The novel pathway significantly reduced the mean time from referral to TAVI (32.4 days vs. 126 days, p<0.00001).
• Total pathway time from diagnosis to TAVI was significantly shorter (89.9 days) compared to traditional referral times (p<0.003).
• Referral acceptance rates for TAVI were substantially higher in the novel pathway (97.8% vs. 49.5%, p<0.00001).

Conclusions:

• A TAVI pathway with local workup in non-surgical centers significantly decreases TAVI procedural time and rejection rates.
• This optimized pathway improves patient access to TAVI.
• Widespread adoption of this approach could enhance TAVI accessibility across centers.