Caseload management and outcome of patients with aortic stenosis in primary/secondary versus tertiary care settings—design of the IMPULSE enhanced registry

Rudolph, Tanja K.; Messika–Zeitoun, David; Frey, Norbert; Lutz, Matthias; Krapf, Laura; Passefort, Stephanie; Fryearson, John; Simpson, Helen; Mortensen, Kai; Rehse, Sebastian; Tiroke, Andreas; Dodos, Fotiní; Mies, Florian; Pohlmann, C.; Kurucova, Jana; Thoenes, Martin; Bramlage, Peter; Steeds, Richard P.

doi:10.1136/openhrt-2019-001019

Cited by 3 publications

(4 citation statements)

References 22 publications

(24 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…IMPULSE enhanced is a multicentre, multinational, observational, prospective registry designed to delineate the case load of patients with AS, outline the management of these patients and determine the appropriateness of treatment decisions at centres with and without on-site access to surgery and percutaneous treatment. The design of the study has been published previously 7. Heart valve centres were designated as HVCs, defined as the availability of the full spectrum of surgical and transcatheter procedures, with associated primary and secondary care centres/office-based cardiologists designated as satellites and defined as facilities without access to surgery and AS interventions.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Severe aortic stenosis management in heart valve centres compared with primary/secondary care centres

Rudolph

Messika–Zeitoun

Frey

et al. 2023

Heart

Self Cite

View full text Add to dashboard Cite

ObjectiveCurrent guidelines recommend use of heart valve centres (HVCs) to deliver optimal quality of care for patients with valve disease but there is no evidence to support this. The hypothesis of this study is that patient care with severe aortic stenosis (AS) will differ in HVCs compared with satellite centres. We aimed to compare the treatment of patients with AS at HVCs (tertiary care hospitals with full access to AS interventions) to satellites (hospitals without such access).MethodsIMPULSE enhancedis a European, observational, prospective registry enrolling consecutive patients with newly diagnosed severe AS at four HVCs and 10 satellites. Clinical characteristics, interventions performed and outcomes up to 1 year by site-type were examined.ResultsAmong 790 patients, 594 were recruited in HVCs and 196 in satellites. At baseline, patients in HVCs had more severe valve disease (higher peak aortic velocity (4.3 vs 4.1 m/s; p=0.008)) and greater comorbidity (coronary artery disease (CAD) (44% vs 27%; p<0.001) prior myocardial infarction (MI) (11% vs 5.1%; p=0.011) and chronic pulmonary disease (17% vs 8.9%; p=0.007)) than those presenting in satellites. An aortic valve replacement was performed more often by month 3 in HVCs than satellites in the overall population (52.6% of vs 31.3%; p<0.001) and in symptomatic patients (66.7% vs 43.2%, p<0.001). One-year survival rate was higher for patients in HVCs than satellites (HR2.19; 95% CI 1.28 to 3.73 total population and 2.89 (95%CI 1.64 to 5.11) for symptomatic patients.ConclusionsOur data support the implementation of referral pathways that direct patients to HVCs performing both surgery and transcatheter interventions.Trial registration numberNCT03112629.

show abstract

Section: Methodsmentioning

confidence: 99%

“…To address this, the IMPULSE enhanced registry was implemented. Its design has been previously reported 7 8. The main aim of the IMPULSE enhanced registry reported here was to assess differences in the management and treatment of patients with AS between HVCs and satellites.…”

Section: Introductionmentioning

confidence: 99%

Severe aortic stenosis management in heart valve centres compared with primary/secondary care centres

Rudolph

Messika–Zeitoun

Frey

et al. 2023

Heart

Self Cite

View full text Add to dashboard Cite

show abstract

“…The design of both the IMPULSE (recruitment March 2015 to January 2017) 17 and IMPULSE enhanced (recruitment March 2017 to October 2018) 18 registries have been described previously. In short, both were prospective, multinational registries of patients with severe AS in Europe.…”

Section: Methodsmentioning

confidence: 99%

Differences in the presentation and management of patients with severe aortic stenosis in different European centres

et al. 2020

Self Cite

View full text Add to dashboard Cite

BackgroundAn investigation into differences in the management and treatment of severe aortic stenosis (AS) between Germany, France and the UK may allow benchmarking of the different healthcare systems and identification of levers for improvement.MethodsPatients with a diagnosis of severe AS under management at centres within the IMPULSE and IMPULSE enhanced registries were eligible.ResultsData were collected from 2052 patients (795 Germany; 542 France; 715 UK). Patients in Germany were older (79.8 years), often symptomatic (89.5%) and female (49.8%) and had a lower EF (53.8%) than patients in France and UK. Comorbidities were more common and they had a higher mean Euroscore II.Aortic valve replacement (AVR) was planned within 3 months in 70.2%. This was higher (p<0.001) in Germany than France/ UK. Of those with planned AVR, 82.3% received it within 3 months with a gradual decline (Germany>France> UK; p<0.001). In 253 patients, AVR was not performed, despite planned. Germany had a strong transcatheter aortic valve implantation (TAVI) preference (83.2%) versus France/ UK (p<0.001). Waiting time for TAVI was shorter in Germany (24.9 days) and France (19.5 days) than UK (40.3 days).Symptomatic patients were scheduled for an AVR in 79.4% (Germany> France> UK; p<0.001) and performed in 83.6% with a TAVI preference (73.1%). 20.4% of the asymptomatic patients were intervened.ConclusionPatients in Germany had more advanced disease. The rate of intervention within 3 months after diagnosis was startlingly low in the UK. Asymptomatic patients without a formal indication often underwent an intervention in Germany and France.

show abstract

“…17 Such is the importance of standardizing and streamlining care associated with the TAVI procedure that other countries and centers are reviewing possible initiatives, including the Canadian Cardiovascular Society Quality Initiative, the TAVI Care and Cure program developed in Rotterdam, and the European IMPULSE registry. [28][29][30][31] In addition, the guidelines from the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery support the QoC initiatives for patients undergoing TAVI, with the focus on patients being treated at heart valve centers/centers of excellence to deliver the best QoC for patients. 5 The BENCHMARK registry will further support the findings from these studies, and determine potential cost savings and improvements in QoC that can be adopted as the new benchmark.…”

Section: Streamlining Of Diagnostic and Procedural Timesmentioning

confidence: 99%

Setting a benchmark for resource utilization and quality of care in patients undergoing transcatheter aortic valve implantation in Europe—Rationale and design of the international BENCHMARK registry

McCalmont

Durand

Lauck

et al. 2021

Clinical Cardiology

Self Cite

View full text Add to dashboard Cite

Background: The use of transcatheter aortic valve implantation (TAVI) for treating aortic stenosis (AS) has increased exponentially in recent years. Despite the availability of clinical practice guidelines for the management of valvular heart disease, disparities in quality of care (QoC) for TAVI patients remain widespread across Europe.Tailored QoC measures will help to reduce resource utilization and improve patient outcomes without compromising patient safety. Using a clear set of QoC measures, the BENCHMARK registry aims to document the progress that can be achieved if such tailored QoC measures are implemented.Methods: The BENCHMARK registry (BENCHMARK) is a non-interventional, multicenter registry in patients with severe symptomatic AS undergoing TAVI with a 1-and 12-months follow-up. BENCHMARK will be conducted at 30 centers across Europe and will enroll a total of 2400 consecutive TAVI patients. Patients suffering from severe symptomatic AS who undergo TAVI with a balloonexpandable transcatheter aortic valve will be included. The registry will comprise four phases: (1) a retrospective baseline evaluation phase; (2) an education phase;(3) an implementation phase; and (4) a prospective effect documentation phase (prospective phase). The registry's primary objectives are to reduce the length of hospital stay and accelerate the post-procedural patient recovery pathway, but without compromising safety. The study started in April 2021 and has an estimated completion date of May 2023.Discussion: BENCHMARK will establish QoC measures to reduce resource utilization, intensive care unit bed occupancy, and overall length of hospitalization with

show abstract

Caseload management and outcome of patients with aortic stenosis in primary/secondary versus tertiary care settings—design of the IMPULSE enhanced registry

Cited by 3 publications

References 22 publications

Severe aortic stenosis management in heart valve centres compared with primary/secondary care centres

Severe aortic stenosis management in heart valve centres compared with primary/secondary care centres

Differences in the presentation and management of patients with severe aortic stenosis in different European centres

Setting a benchmark for resource utilization and quality of care in patients undergoing transcatheter aortic valve implantation in Europe—Rationale and design of the international BENCHMARK registry

Contact Info

Product

Resources

About