2023, Volume 30, Supplement 1: Overcoming barriers to treating severe aortic stenosis

Severe aortic stenosis (AS) has a poor prognosis1 – the five-year mortality rate, estimated at 67%, is worse than in many cancers and even higher (94%) in those who do not undergo intervention.1–3 However, while patients with suspected cancer may expect to enter a treatment pathway within two weeks of presentation, those with severe AS may wait many months before diagnosis, assessment or treatment....

Aortic stenosis (AS) is characterised by progressive narrowing of the aortic valve,1 which may be clinically silent or associated with a range of symptoms caused by reduced cardiac output, including shortness of breath, angina and syncope.2 Symptomatic patients are typically elderly with multiple comorbidities.3 Severity of AS is determined using an integrated approach based on echocardiographic parameters, valve morphology, blood pressure and symptoms.4 Both moderate and severe AS are associated with poor prognosis, but whereas severe AS is an indication for prompt intervention,5 the benefits of intervention in moderate AS remain under investigation.6,7 Herein, we describe the epidemiology of AS, the history and evolution of AS treatments, and key studies that have driven the development of AS treatment guidelines....

Transcatheter aortic valve implantation (TAVI) has revolutionised the treatment of severe aortic stenosis (AS) over the last 15 years, improving patient survival regardless of operative risk and reducing treatment burden.1–4 Management aims in severe AS are promptly delivering appropriate treatment for patients and optimising survival and quality of life outcomes. Despite adequate treatment options, many patients with severe symptomatic AS remain undiagnosed or suffer delays in referral for treatment, resulting in poor outcomes.5,6 Access-to-care challenges during the COVID-19 pandemic have exacerbated these issues but have also highlighted the importance of developing a streamlined, consistent and robust treatment pathway for patients with severe AS.7 This article discusses how to break down the barriers to successful detection, referral and treatment of patients with severe AS, and provides strategies to achieve a streamlined patient pathway based on a standardised network of healthcare professionals....

The incidence of aortic stenosis (AS) worldwide is expected to increase steeply over the next three decades, mainly driven by an ageing population.1,2 In the face of this emerging epidemic, the demand for AS treatment resources is increasing, including the provision of surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI). The COVID-19 pandemic added challenges for patients with AS, who cannot delay their treatment without impacting clinical outcomes.3 In this setting, TAVI is recognised as an effective and efficient solution for treating AS in eligible patients, offering no significant delays in treatment (depending on local resources), no excess complications or mortality, and a shorter hospital length-of-stay compared to treatment before COVID 19.4,5 A successful TAVI programme aims to resolve AS safely and efficiently, enabling the patient to be discharged home rapidly without sustaining in-hospital complications and thus improving outcomes. This requires individualised treatment decisions based on patient presentation and preferences, and available local resources. Data from clinical trials and real-world studies have driven improvements in the care coordination for patients undergoing TAVI, transforming patient pathways toward the TAVI programme goals.6–12 Based on these data, a streamlined TAVI pathway aimed at safe and early discharge of patients is recommended to optimise outcomes and improve access to care....