{
  "abstract": "Introduction Aortic stenosis (AS) is a common valvular heart disease in an aging population. 1 Although patients may remain asymptomatic for prolonged periods, symptoms onset is associated with poor prognosis without valve intervention.2 Transcatheter Aortic Valve Implantation (TAVI) is an established alternative to surgical aortic valve replacement; however, mortality while awaiting TAVI remains significant.3 Referral pathways require optimisation.Methods This retrospective single-centre service audit was conducted at a non-surgical TAVI referral centre. Consecutive patients diagnosed with severe AS between September 2024 and October 2020 were identified from the echocardiography database. Severe AS was defined by a peak transvalvular gradient ≥64 mmHG, aortic valve area <1.0 cm 2, or MDT-confirmed severity. Demographic and clinical data were extracted from the electronic records. Time intervals between key pathway stages were calculated from diagnostic echocardiography.Results A total of 142 patients with severe aortic stenosis were identified during the study period. The median age was 80 years (interquartile range [IQR] 73-88) and 59.9% were male. Breathlessness was the most common presenting symptom (42.3%); 17.6% were asymptomatic at referral. Echocardiography confirmed severe AS with a median peak gradient of 71 mmHg (IQR 64 – 85) and median AVA of 0.83cm 2 (IQR 0.72 – 0.92).Eighty-one patients underwent MDT discussion, of whom 37 (46%) were recommended to undergo TAVI, 24 (30%) SAVR and 19 (23%) medical management. Among patients undergoing TAVI, 21 (57%) were managed as outpatients and 16 (43%) required inpatient admission (figure 1).Among patients undergoing TAVI with complete pathway data (N = 23), median time from echocardiography to valve implantation was 50 days (IQR 21-100). Marked differences were observed between inpatient and outpatient pathways, with inpatients undergoing TAVI substantially sooner than outpatients (median 20 [IQR 17 – 28] vs 100 [IQR 53 – 188 days). Delays were predominantly observed prior to MDT decision-making, with longer intervals from echocardiography to MDT review and CT planning in outpatients. In contrast, the interval from MDT to TAVI was comparatively short and similar between inpatient and outpatient groups (figure 2).Of the remaining patients recommended for TAVI, two died while awaiting intervention, one underwent SAVR, six underwent TAVI with incomplete pathway data, and five remain on outpatient waiting lists at the time of analysis (median waiting time 262 days [IQR 165-452]), accounting for all accepted patients.Conclusion This audit demonstrates that delays in the management of severe aortic stenosis arise predominantly before MDT decision-making, with substantially longer times observed in outpatient pathways. In contrast, MDT-to-TAVI intervals were comparatively short, indicating effective post-decision processes. Targeted redesign of early diagnostic and outpatient pathways may improve timeliness of care.References Solomon MD, Go AS, Leong T, Garcia E, Le K, Philip F, et al. The association of aortic stenosis severity and symptom status with morbidity and mortality. JACC Adv. 2020 Jul 21;4(8):101962. doi:10.1016/j.jacadv.2020.101962. PMID:40695136. PMCID:PMC12304764.Bhushan S, Liu X, Wu Q, Gao K. Recent updates on asymptomatic and symptomatic aortic valve stenosis: its diagnosis, pathogenesis, management and future perspectives. Curr Prob Cardiol. 2024;49(7):102631. doi:10.1016/j.cpcardiol.2024.102631.Poinsignon H, Godin M, Landolff Q, Heroguelle V, Villecourt A, Tassan-Mangina S, et al. Death on waiting list for transcatheter aortic valve implantation: current incidence, clinical characteristics and predictive factors. Arch Cardiovasc Dis. 2020;118(6-7):374–381. doi:10.1016/j.acvd.2020.02.003Abstract 341 Figure 1Care pathway for patients referred with severe aortic stenosis, illustrating inpatient (IP) and outpatient (OP) referral routes, multidisciplinary team (MDT) decision-making, and subsequent management pathways. Timing analyses were anchored to the date of diagnostic echocardiography. Median time from echocardiographic diagnosis of severe aortic stenosis to transcatheter aortic valve implantation (TAVI) is shown for patients proceeding to TAVI, with stratification by inpatient and outpatient statusAbstract 341 Figure 2Median time intervals within the care pathway for patients with severe aortic stenosis progressing to transcatheter aortic valve implantation (TAVI). Time intervals are reported as median and interquartile range (IQR) and were calculated from the date of diagnostic echocardiography. N denotes the number of patients contributing to each interval",
  "authors": [
    {
      "affiliations": [
        "Department of cardiology, Midland Metropolitan University Hospital"
      ],
      "name": "Syeda Asma Zahoor"
    },
    {
      "affiliations": [
        "Department of cardiology, Midland Metropolitan University Hospital"
      ],
      "name": "Kumail Abbas Dewji"
    },
    {
      "affiliations": [
        "Department of cardiology, Midland Metropolitan University Hospital"
      ],
      "name": "Nazia Yeasmin"
    },
    {
      "affiliations": [
        "Department of cardiology, Midland Metropolitan University Hospital"
      ],
      "name": "Sahar Baraki"
    },
    {
      "affiliations": [
        "Department of cardiology, Midland Metropolitan University Hospital"
      ],
      "name": "Fairoz Abdul"
    },
    {
      "affiliations": [
        "Department of cardiology, Midland Metropolitan University Hospital"
      ],
      "name": "Mohammed Shamim Rahman"
    }
  ],
  "title": "341 Timing of care pathways in patients with severe aortic stenosis: a single-centre experience",
  "uid": "283b2855-3867-5e60-9e97-57a1eb31acd6"
}