Lutz Matthias, Messika-Zeitoun David, Rudolph Tanja K, Schulz Eberhard, Thambyrajah Jeetendra, Lloyd Guy, Lauten Alexander, Frey Norbert, Kurucova Jana, Thoenes Martin, Deutsch Cornelia, Bramlage Peter, Steeds Richard Paul
Department of Cardiology and Angiology, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany.
Department of Cardiology, University of Ottawa Heart Institue, Ottawa, Ontario, Canada.
Open Heart. 2020 Sep;7(2). doi: 10.1136/openhrt-2020-001345.
An investigation into differences in the management and treatment of severe aortic stenosis (AS) between Germany, France and the UK may allow benchmarking of the different healthcare systems and identification of levers for improvement.
Patients with a diagnosis of severe AS under management at centres within the IMPULSE and IMPULSE enhanced registries were eligible.
Data were collected from 2052 patients (795 Germany; 542 France; 715 UK). Patients in Germany were older (79.8 years), often symptomatic (89.5%) and female (49.8%) and had a lower EF (53.8%) than patients in France and UK. Comorbidities were more common and they had a higher mean Euroscore II.Aortic valve replacement (AVR) was planned within 3 months in 70.2%. This was higher (p<0.001) in Germany than France/ UK. Of those with planned AVR, 82.3% received it within 3 months with a gradual decline (Germany>France> UK; p<0.001). In 253 patients, AVR was not performed, despite planned. Germany had a strong transcatheter aortic valve implantation (TAVI) preference (83.2%) versus France/ UK (p<0.001). Waiting time for TAVI was shorter in Germany (24.9 days) and France (19.5 days) than UK (40.3 days).Symptomatic patients were scheduled for an AVR in 79.4% (Germany> France> UK; p<0.001) and performed in 83.6% with a TAVI preference (73.1%). 20.4% of the asymptomatic patients were intervened.
Patients in Germany had more advanced disease. The rate of intervention within 3 months after diagnosis was startlingly low in the UK. Asymptomatic patients without a formal indication often underwent an intervention in Germany and France.
对德国、法国和英国重度主动脉瓣狭窄（AS）管理和治疗差异的调查，可能有助于对不同医疗体系进行基准对比，并找出改进的方法。
入选了IMPULSE和IMPULSE增强型注册研究中各中心正在管理的重度AS诊断患者。
收集了2052例患者的数据（德国795例；法国542例；英国715例）。德国患者年龄更大（79.8岁），常有症状（89.5%）且女性占比（49.8%）更高，与法国和英国患者相比射血分数（EF）更低（53.8%）。合并症更常见，平均欧洲心脏手术风险评估系统（Euroscore）II更高。70.2%的患者计划在3个月内进行主动脉瓣置换（AVR）。德国这一比例高于法国/英国（p<0.001）。在计划进行AVR的患者中，82.3%在3个月内接受了手术，且呈逐渐下降趋势（德国>法国>英国；p<0.001）。在253例患者中，尽管计划进行AVR，但并未实施。与法国/英国相比，德国对经导管主动脉瓣植入术（TAVI）有强烈偏好（83.2%，p<0.001）。德国（24.9天）和法国（19.5天）的TAVI等待时间短于英国（40.3天）。有症状的患者中，79.4%计划进行AVR（德国>法国>英国；p<0.001），83.6%进行了手术，且更倾向于TAVI（73.1%）。20.4%的无症状患者接受了干预。
德国患者病情更严重。英国在诊断后3个月内的干预率低得惊人。在德国和法国，无正式指征的无症状患者常接受干预。
