Improving patients' journey of care with valvular heart disease: findings of European survey on the role of clinical valve coordinatior and insights from nursing

Background The Association of Cardiovascular Nursing & Allied Professions (ACNAP) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the European Society of Cardiology (ESC) recently endorsed a common clinical consensus statement supporting the role of Clinical Valve Coordinators to support patients, contribute unique expertise to team-based care, and help programmes expand access to care. This position aligns with international guidelines that highlight Clinical Valve Coordinator play a vital role as a central member of the multidisciplinary team. Despite this guidance, the role of the Clinical Valve Coordinator is unevenly adopted in Europe. We sought to conduct a survey across diverse European countries to describe if, and how the role is operationalised, how nursing leadership is enacted, and if there is alignment with the consensus outlined by ACNAP and EAPCI. Methods In collaboration with nursing and medicine representatives, we co-constructed a survey to scan the presence of Clinical Valve Coordinators, and describe the responsibilities, competencies, infrastructure and organisational integration of the role, or barriers to role adoption. We conducted a descriptive analysis of the findings by hospital and country/region. Results We recruited a dyad of nursing and medical lead from each country to mobilise their local networks to participate. We received responses from 275 hospitals from 8 countries/regions, completed by nursing (n=107, 38.9%), medicine (n=131, 47.6%) and managers (n=37, 13.5%). The role of the Clinical Valve Coordinator was established in 168 hospitals (61.1%), most often held by a clinician (nurse: n=111, 40.7%), with variations across countries (UK: 97.7% nursing vs. Spain: 62.5% physician). Most reported position titles included "TAVI Coordinator" (n=68. 40.5%), "TAVI Nurse" (n=42, 25.0%), and "Structural Heart Nurse" (n=17, 10.2%). Responsibilities included all structural heart procedures (n=91, 54.2%), TAVI only (n=62, 36.9%), and shared structural and PCI and/or surgery (n=15, 8.9%). Variation in responsibilities was reported within and across countries/regions; when the role was held by nursing, responsibilities were more likely to centre on core components of the role outlined in the ACNAP/EAPCI statement. Alignment with the ACNAP Core Curriculum was inconsistent. The role was absent in 104 (38.9%) centres; 60% reported considering implementation, with lack of funding (30.8%), poor understanding of the role (19.8%) and insufficient management and/or physician support (18.1%) being the most cited barriers. Conclusions Cardiovascular nursing competencies are essential to optimise the role and impact of Clinical Valve Coordinators. There are opportunities to strengthen the education, training and career ladder of this group of clinicians to support the care requirements of people with complex valvular heart disease. Research and policy efforts are needed to address this gap.