Best Practice Recommendations for Optimizing Care in Structural Heart Programs: Planning Efficient and Resource Leveraging Systems (PEARLS)

Abstract

The COVID19 pandemic brought unprecedented disruption to healthcare. Staggering morbidity, mortality, and economic losses prompted the review and refinement of care for structural heart disease (SHD). To mitigate negative impacts in the face of crisis or capacity constraints, this paper offers best practice recommendations for Planning Efficient and Resource Leveraging Systems (PEARLS) in structural heart programs. A systematic assessment is recommended for hospital capacity, Heart Team roles and functions, and patient and procedural risks associated with increased resource utilization. Strategies, tactics, and pathways are provided for the delivery of patient-centered, efficient and resource-leveraging care from referral to follow-up. Through the optimal use of capacity and resources, paired with dynamic triage, forecasting, and surveillance, Heart Teams may aspire to plan and implement an optimized system of care for SHD.

Never Let a Crisis Go to Waste: What Have We Learned About Clinical Pathways for Transcatheter Structural Heart Interventions?

“…Pop et al allude to the multicenter PROTECT-TAVR study for further validation. For now, capacity principles as highlighted in the crisis literature 12 and best practice recommendations for optimizing care in structural heart programs 4 , 13 offer foundational guidance for adapting clinical pathways in site-specific ways. Until there is evidence of demonstrable benefit, SDD would be considered for select patients when a hospital is at restricted capacity, and may not be warranted at reduced or conventional capacity.…”

“…As clinicians shaping structural heart clinical pathways, we anticipated a similar trajectory for structural heart therapy, launched SDD, 8 and crafted frameworks for program optimization and systems of care. 13 We envisioned a not-too-distant future of ambulatory surgical centers for transcatheter structural heart intervention, provided that emergency care protocols and U.S. reimbursement concerns could be thoughtfully mitigated. These strategies may be more favorable for transcatheter mitral edge to edge repair, 18 , 19 left atrial appendage occlusion, and transcatheter closure of patent foramen ovale or interatrial septal defects, which have decreased risk of conduction disorder/permanent pacemaker or vascular complications as compared to TAVR.…”

Temporary Mechanical Circulatory Support Coordinator: Conception and Implementation of a Novel Role

“…1 Care for patients with durable left ventricular assist devices, heart transplants, complex arrhythmias, and structural heart interventions has been enhanced by incorporating highly specialized nurses, often dubbed coordinators. 2,3 These roles are now foundational for nearly all high-complexity cardiovascular diseases.…”