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Published on: June 3, 2018
Time to TAVI: streamlining the pathway to treatment
Lynsey Jane Hewitson1, Suzane Cadiz2, Sameeha Al-Sayed2
1Great Western Hospitals NHS Foundation Trust, Swindon, UK lynsey.hewitson@nhs.net.
Insights
A new transcatheter aortic valve implantation (TAVI) pathway streamlines patient workup locally, significantly reducing treatment delays and improving TAVI acceptance rates. This approach enhances access to TAVI for severe aortic stenosis patients.
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.
Introduction:
Severe aortic stenosis is a major cause of morbidity and mortality. The existing treatment pathway for transcatheter aortic valve implantation (TAVI) traditionally relies on tertiary Heart Valve Centre workup. However, this has been associated with delays to treatment, in breach of British Cardiovascular Intervention Society targets. A novel pathway with emphasis on comprehensive patient workup at a local centre, alongside close collaboration with a Heart Valve Centre, may help reduce the time to TAVI.
Methods:
The centre performing local workup implemented a novel TAVI referral pathway. Data were collected retrospectively for all outpatients referred for consideration of TAVI to a Heart Valve Centre from November 2020 to November 2021. The main outcome of time to TAVI was calculated as the time from Heart Valve Centre referral to TAVI, or alternative intervention, expressed in days. For the centre performing local workup, referral was defined as the date of multidisciplinary team discussion. For this centre, a total pathway time from echocardiographic diagnosis to TAVI was also evaluated. A secondary outcome of the proportion of referrals proceeding to TAVI at the Heart Valve Centre was analysed.
Results:
Mean±SD time from referral to TAVI was significantly lower at the centre performing local workup, when compared with centres with traditional referral pathways (32.4±64 to 126±257 days, p<0.00001). The total pathway time from echocardiographic diagnosis to TAVI for the centre performing local workup was 89.9±67.6 days, which was also significantly shorter than referral to TAVI time from all other centres (p<0.003). Centres without local workup had a significantly lower percentage of patients accepted for TAVI (49.5% vs 97.8%, p<0.00001).
Discussion:
A novel TAVI pathway with emphasis on local workup within a non-surgical centre significantly reduced both the time to TAVI and rejection rates from a Heart Valve Centre. If adopted across the other centres, this approach may help improve access to TAVI.
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