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FEATURED CONTENT
The burden of aortic stenosis undertreatment
Problem definition:
Aortic valve replacement (AVR) treatment rates are consistently lower than the growing prevalence of aortic stenosis.
Despite advancements and greater access to transcatheter aortic valve replacement (TAVR) many severe aortic stenosis (sAS) patients still go without treatment.
Of people with indication or potential indication for AVR received treatment
Problem impact:
Treatment delays can threaten patient lives.
Aortic stenosis (AS) progression worsens symptoms, lowers life quality, increases mortality risk, and is more costly for the health system.
Increased mortality risk for sAS patients after two years without AVR
Increase in cost of treatment associated with delays in care
Problem explanation:
Under-identification and under-referral contribute to undertreatment.
Of patients with moderate or severe AS are not clinically recognized
Of untreated patients were never referred to a heart team for evaluation
Solution:
Prompt referral to a multidisciplinary heart team can mitigate negative outcomes.
A comprehensive patient capture strategy that enables improved patient identification and referral to treatment has been proven to help:
- Increase procedure volumes
- Reduce time to treatment
- Reduce cost of care
- Improve quality and patient outcomes
Toolkit overview
Audience: Cardiovascular service line leaders and/or structural heart (SH) program directors and managers.
Goal: Demonstrate how incomplete patient capture contributes to aortic stenosis (AS) undertreatment, explain the burden of undertreatment, and highlight how SH programs can address this gap by leveraging specific opportunities to improve patient identification and management.
How to use this toolkit: SH program leaders should use the toolkit as a guide for how to improve AS patient capture. Review the included sections to identify your top opportunities for improving AS undertreatment and learn how other leading organizations are tackling this challenge.
Understand the current AS patient capture landscape and imperative to address undertreatment
Instructions: Use this section to understand and communicate the critical need to address AS underdiagnosis and undertreatment. The following pages of the accompanying PDF will equip SH leaders with the data and insights required to explain the significance of this work to leaders within their organization.
What you’ll find (pages 4–11):
- Evidence on the underdiagnosis and undertreatment of AS patients.
- Definition of patient capture and its key role in solving the underdiagnosis and undertreatment problem.
- Benefits of building a more robust and effective patient capture system to increase access to life-saving treatment.
Causes for AS undertreatment span the entire care journey
Effectively addressing AS undertreatment means solving for various challenges across the care journey. We outlined three key areas for improvement based on common factors that contribute to undertreatment.
Identifying patients and referring to heart team
- Low awareness/misinterpretation of symptoms as signs of aging: Failure to recognize heart murmurs, chest pains, shortness of breath, fatigue, etc. as signs of AS.
- Complex nature of diagnosis: Failure to integrate multiple points of disparate data, including high-quality imaging, echocardiogram (echo) report, caregiver feedback, complete patient record, patient-reported outcomes, etc.
- Early discharge: Premature end of care encounter without referral for multidisciplinary heart team evaluation.
- Lack of upstream patient capture-related quality metrics: Historical lack of provider quality and clinical accountability standards targeting patient capture.
- Outdated and/or inconsistent referral guidance: Perceived excessive surgical risk because of advanced age, comorbidities, patient demographic inequities, etc.
Tracking patients through the system
- Care fragmentation: Lack of coordination between care teams involved in pre-procedure care and patient follow-up.
- Delayed retesting: Absence of proper disease progression monitoring for early stage AS patients.
- Bottlenecks: Process barriers lead to poor patient flow, extended treatment wait times, increased costs, compromised care quality, etc.
Improving patient and health system outcomes
- Access concerns: Inability to accommodate patient influx from improved patient capture due to lack of staff, screening/consult capacity, and physical space for care delivery.
- Systemic and physical barriers to care: Mistrust of healthcare system, cost, lack of regional access to procedure, comorbidities, etc.
"When you identify people early with valvular disease, then you’re protecting and preserving cardiac tissue ... So, with outreach in the early stages of AS and early identification of patients, hopefully we’ll be very successful in not only improving our care delivery, but also the experience of our patients across the service line and health system."
Evaluate potential areas of improvement and associated strategies for AS patient capture
Instructions: Using the tools and industry best practices outlined in this section, evaluate opportunities to improve patient capture and treatment for AS. Then, determine which strategies are the best fit for your organization based on existing capabilities and how much additional time and resources you’re able to invest.
What you’ll find (pages 12–23):
- Compare the benefits, cautions, and levels of investment associated with different strategies.
- Guidance on designing your own patient capture solution.
- Tools to help you assess your program’s opportunities for impact and readiness to invest:
- Calculation tool: Assess your organization’s potential to increase patient capture (page 13).
- Planning and comparison tool: Compare your TAVR usage to industry benchmarks (page 14).
- Checklist tool: Evaluate your readiness to implement new solutions for enhanced AS patient capture (page 15).
- Best practices tool: Lessons learned across solutions for addressing undertreatment (page 22).
- Checklist tool: Consider which strategies to include as part of your solution to improve patient capture (page 23).
"We approached this project twofold: as a growth strategy for the service line and as a quality improvement strategy to identify undertreated valvular heart disease patients within our organization."
See how five health systems are approaching improvements in AS patient capture
Instructions: Review approaches to improvements to AS patient capture at five health systems. During your review, identify and assess strategies and components that may be effective within your organization.
What you’ll find (pages 24–30):
- Insights from health system leaders on how their patient capture strategies met the needs of their patient population and addressed unique hurdles.
- Comprehensive operationalization of each strategy’s tackled problem, strategy approach, outcome measurement, and future directions.
- Organizations profiles:
- Community Heart and Vascular: Begin manually, leverage existing platforms and gradually automate for efficiency.
- Morristown Medical Center: Use NLP to pinpoint AS clinical markers in extensive patient datasets.
- Wellstar Center for Cardiovascular Care: Standardize referrals and improve AS patient capture data with automated alerts
- Preston Medical Center (a pseudonym): Boost detection and follow-up care with cardiologist referral for AS at the point of care.
- Virginia Mason Franciscan Health: Deploy AI in provider workflows to identify AS, increase volumes, and reduce staff burnout.
"The technology is the easy part. Getting it right and making sure what you built is producing the results that you want, that falls on the people. Technology isn’t the solution; it’s just a facilitator."
Edwards Lifesciences is the leading global structural heart innovation company, driven by a passion to improve patient lives. Through breakthrough technologies, world-class evidence and partnerships with clinicians and healthcare stakeholders, our employees are inspired by our patient-focused culture to deliver life-changing innovations to those who need them most.
This report is sponsored by Edwards Lifesciences, an Advisory Board member organization. Representatives of Edwards Lifesciences helped select the topics and issues addressed. Advisory Board experts wrote the report, maintained final editorial approval, and conducted the underlying research independently and objectively. Advisory Board does not endorse any company, organization, product or brand mentioned herein. To learn more, view our editorial guidelines.
This report is sponsored by Edwards Lifesciences. Advisory Board experts wrote the report, maintained final editorial approval, and conducted the underlying research independently and objectively.
Michaela Dipillo
Posted on December 05, 2024
Updated on December 16, 2024
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