Quality of care assessment and improvement in aortic stenosis - rationale and design of a multicentre registry (IMPULSE)
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Key result
The IMPULSE registry is designed to evaluate whether facilitated data relay from a dedicated echocardiography nurse to the referring physician improves the rate of appropriate intervention in patients with severe aortic stenosis.
Why the study?
Does facilitated data relay from an echocardiography nurse to the referring physician improve the rate of SAVR or TAVI in patients newly diagnosed with severe aortic stenosis?
Population
Adults newly diagnosed with severe aortic stenosis by echocardiography. Target n>2500 across 25 centres in…
Comparison
Facilitated data relay. vs Standard care / observational phase.
Design
Cohort
Follow-up
3 months (main), 1 year (vital status)
Authors
Discussion
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Member takes
Implication
Adherent monitoring was associated with higher survival in severe AS; leaves open whether adherence interventions improve outcomes.
Structured PICO
Does facilitated data relay from an echocardiography nurse to the referring physician improve the rate of SAVR or TAVI in patients newly diagnosed with severe aortic stenosis?
P
Population
A planned registry of over 2,500 adults with newly diagnosed severe aortic stenosis across 10 European countries, followed for 3 months to assess the impact of facilitated data relay on treatment decisions.
I
Intervention
Facilitated data relay (a dedicated echocardiography study nurse contacts the referring physician 1 week after diagnosis to advise of the severe AS diagnosis and request intended treatment plans).
C
Comparator
Standard care / observational phase (no contact made with the referring physician regarding the study until follow-up at 3 months).
O
Outcome
Rate of surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) by the referring physician at 3-month follow-up.
The IMPULSE registry study protocol outlines a design to evaluate whether a simple facilitated data relay intervention can improve guideline adherence and referral rates for SAVR or TAVI in patients newly diagnosed with severe aortic stenosis.
Limitations
- Observational nature limits control over patient characteristics
- Does not assess patient/family preferences in decision-making
- Short follow-up of 3 months limits long-term outcome assessment
- Physician awareness of study participation may artificially improve decision-making
- Observational nature means little control over patient characteristics, potentially resulting in uneven distribution between phase groups
- Does not investigate the contribution of patient/family preferences to the treatment decision-making process
- Short study duration (3 months) limits evaluation of long-term consequences of management
- Physician awareness of study participation during the interventional phase may prompt more conscientious decision-making, over-estimating the real-world effect
Cite This Study
Frey et al. (2017) studied Severe aortic stenosis (n=2,500). Facilitated data relay vs. Standard care (no contact) was evaluated on Rate of SAVR or TAVI by the referring physician at 3-month follow-up. The IMPULSE registry is designed to evaluate whether facilitated data relay from a dedicated echocardiography nurse to the referring physician improves the rate of appropriate intervention in patients with severe aortic stenosis.
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