Key result
Implementing Heart Valve Clinic access priority criteria is linked to ~33% more intervention referrals.
Why the study?
Heart Valve Clinics are promoted by clinical guidelines, but real-world outcome assessments remain limited.
Does the introduction of access priority criteria improve appropriateness and efficiency of patient management in a Heart Valve Clinic?
Observational (n=1,047)
No
Does the introduction of access priority criteria improve appropriateness and efficiency of patient management in a Heart Valve Clinic?
Absolute Event Rate: 39% vs 29.4%
p-value: p=0.001
The implementation of standardized access criteria in a Heart Valve Clinic increases the appropriate referral of complex patients for invasive treatment without compromising operative mortality.
Supports priority criteria to boost appropriate valve referrals in clinics; leaves open need for randomized outcome confirmation.
BACKGROUND: Valvular heart disease (VHD) requires optimized outpatient management that is generally considered to be best delivered by a dedicated, multidisciplinary team (Heart Valve Clinic [HVC]). Although HVC is promoted by clinical guidelines and organized in many centers, real world outcome assessments are limited. Thus, we evaluated the performance, clinical and management outcomes during a 6-year experience with an original HVC model. METHODS: By interrogating the local database, 1047 consecutive patients admitted to the HVC from January 2015 to October 2020 were found. Management and mortality were checked for all patients. After 3 years of HVC activity, in order to improve appropriateness and efficiency, access priority criteria were introduced. Thus, the study population was divided in two period subgroups (before and after access criteria introduction) that were compared. RESULTS: A total of 1047 consecutive patients admitted to the HVC constituted the study population; 346 patients (33%) were recommended for invasive treatment. After a mean follow-up of 25.7±3.1 months, 37 patients (3.5%) died. When comparing study periods, statistically significant increase inpatients' complexity and VHD severity was noticed in Period 2, also translating into higher rate of referral to intervention (39.0% vs. 29.4% in Period 1; P=0.001). Finally, despite higher rate of elderly and frail patients, operative mortality was not jeopardized. CONCLUSIONS: The present study reports a comprehensive assessment of the characteristics and outcomes achieved through an original HVC model. Standardization of access criteria supports the HVC improvement.
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Pavone et al. (2022) conducted an observational in Valvular heart disease (n=1,047). Heart Valve Clinic model with access priority criteria (Period 2) vs. Heart Valve Clinic model without access priority criteria (Period 1) was evaluated on Referral to intervention (p=0.001). Implementing access priority criteria in a Heart Valve Clinic significantly increased the rate of referral to intervention compared to the prior period (39.0% vs. 29.4%; P=0.001).
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