Urgent action needed to clear heart surgery backlog, research finds

Urgent action is needed to clear the backlog of people with common heart disease who are waiting for lifesaving treatment, according to research co-led by Professor Keele.

Researchers have warned that a lack of action could lead to the death of thousands of people while waiting for treatment, with the Covid-19 pandemic leading to the postponement of thousands of heart procedures and record waiting lists. Previous work estimated that 4,989 people in England with severe aortic stenosis missed life-saving treatment between March and November 2020.

The study, supported by the British Heart Foundation, was published today in BMJ Open.

Aortic stenosis develops when the aortic valve of the heart narrows, which restricts blood flow out of the heart. Prompt treatment is vital for people diagnosed with severe aortic stenosis, as around 50% will die within two years of the onset of symptoms.

Today, an international team of researchers modeled the impact that increasing treatment capacity and using a faster, less invasive treatment option would have on waiting lists. Even in the best-case scenario, they found that the waiting list would take nearly a year to disappear, and more than 700 people would die while waiting for treatment.

The traditional treatment for aortic stenosis is to replace the narrowed valve, most often with open-heart surgery (a surgical aortic valve replacement, SAVR). However, a new keyhole procedure called transcatheter aortic valve implantation (TAVI) is gaining popularity and is now recommended for patients aged 75 and over.

Researchers studied the impact that increasing processing capacity and converting some operations to the faster TAVI procedure would have on the backlog. They looked at how long it would take to clear the backlog and how many people would die while waiting for treatment.

They found that the best and most feasible option involved a combination of increasing capacity by 20% and converting 40% of procedures from SAVR to TAVI. This would clear the backlog in 343 days with 784 deaths while people wait for treatment.

The team says they want to see greater collaboration locally and nationally to agree on needed changes that can ensure people with severe aortic stenosis receive life-saving treatment as quickly as possible.

Professor Mamas Mamas, Professor of Cardiology at Keele University and Consultant Cardiologist at North Midlands NHS Trust University Hospitals, was one of the lead researchers in the study.

He said: “Before the pandemic, around 13,500 SAVR and TAVI procedures were carried out each year across the UK. Increasing capacity by 20% would mean one or two additional TAVI procedures each week per centre. We believe that with local and national collaboration, this increase In addition, we have created an algorithm that NHS Trusts can use to determine the best approach locally.

“Since November 2020 the UK has been hit by new waves of Covid-19 which have resulted in extreme pressure on the NHS and further delays in treatment. We expect the number of people waiting for treatment in recent months is even higher than the figure we used in our study.

“Doing nothing is simply not an option. If we continue as we are now, thousands of people will die from untreated aortic stenosis.”

Dr Sonya Babu-Narayan, Associate Medical Director at the British Heart Foundation and Consultant Cardiologist, added: “We welcome the use of innovative cardiovascular procedures which can reduce the need for open heart surgery where appropriate and where their use will bring the greatest benefit to patients.

“But, as this modeling study shows, even increased use of this faster, less invasive procedure will not be enough to overcome the impact of Covid-19-related delays and prevent people with aortic stenosis from dying in the first place. waiting for treatment.

“Cardiac care cannot wait. The NHS desperately needs additional resources to help it deal with the backlog of care and to ensure that cardiac patients receive the treatment and care they need.”

This research was partly funded by the EPSRC Cambridge Center for Mathematics of Information in Healthcare.

Source:

Journal reference:

Stickies, CP, et al. (2022) Post-COVID-19 aortic stenosis: a mathematical model on waiting lists and mortality. BMJ open. doi.org/10.1136/bmjopen-2021-059309.

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