80 Impacting the quality of care in severe aortic stenosis using facilitated data transfer – delay to intervention in the UK versus other european countries (impulse registry)
| Autor: | Guy Lloyd, Matthias Lutz, Peter Bramlage, Jeetandra Thambyraja, Richard P. Steeds, Norbert Frey, Jana Kurucova, David Messika-Zeitoun, Tanja K. Rudolph |
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| Rok vydání: | 2018 |
| Předmět: |
Pediatrics
medicine.medical_specialty business.industry medicine.medical_treatment media_common.quotation_subject EuroSCORE Chest pain medicine.disease Stenosis Concomitant Intervention (counseling) medicine Impulse (psychology) Observational study medicine.symptom business Watchful waiting media_common |
| Zdroj: | Valve Disease/Pericardial Disease/Cardiomyopathy. |
| Popis: | Introduction Many patients with severe AS are inappropriately denied intervention and continue to present late with advanced symptoms. IMPULSE is a prospective, multicentre registry conduced in 23 centres across 9 European countries, investigating the efficacy of facilitated data transfer (FDT) in improving time to intervention in severe AS. Results from the 3 large UK centres were compared to those of other large centres in the rest of Europe. Methods Hospitals with all treatment options (sAVR, TAVI, BAV) on site were asked to document, over a 1 year period, patients with severe AS that presented with or without symptoms. A 3 months purely observational phase A was followed by a 6 months interventional phase (FDT), and a 3 months observational phase B to investigate a legacy effect. Results: A total of 2171 pts were enrolled of which 515 were recruited in the UK. Patients in the UK had a mean age of 78.1±11.0 years, 46.8% were female, the mean log EuroScore I was 17.1±13.3 and 77.9% of the patients were considered symptomatic based on the presence of chest pain, shortness of breath, dizziness on exertion. These baseline characteristics did not differ between the UK and the rest of Europe. Concomitant valve disease aortic (17.4 vs 5.1%), mitral (18.6 vs 8.3%) and tricuspid (16.2 vs 5.3%) regurgitation was more frequently diagnosed in the UK than the rest of Europe (all p Conclusions Management practices differ in the UK compared to Europe in patients with severe AS, with more frequent selection of watchful waiting and medical management. FTD increased the number of patients going for intervention, although rates remained low given that the study recruited only patients with severe aortic stenosis confirmed on echo and almost 4/5ths were symptomatic. In addition, there is a significant delay in the UK compared to Europe between decision making and actual performance of TAVI. |
| Databáze: | OpenAIRE |
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