Department of Cardiovascular Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
Department of Cardiovascular Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy -
Minerva Cardiol Angiol. 2023 Apr;71(2):189-198. doi: 10.23736/S2724-5683.22.05998-1. Epub 2022 Jun 10.
Valvular heart disease (VHD) requires optimized outpatient management that is generally considered to be best delivered by a dedicated, multidisciplinary team (Heart Valve Clinic [HVC]). Although HVC is promoted by clinical guidelines and organized in many centers, real world outcome assessments are limited. Thus, we evaluated the performance, clinical and management outcomes during a 6-year experience with an original HVC model.
By interrogating the local database, 1047 consecutive patients admitted to the HVC from January 2015 to October 2020 were found. Management and mortality were checked for all patients. After 3 years of HVC activity, in order to improve appropriateness and efficiency, access priority criteria were introduced. Thus, the study population was divided in two period subgroups (before and after access criteria introduction) that were compared.
A total of 1047 consecutive patients admitted to the HVC constituted the study population; 346 patients (33%) were recommended for invasive treatment. After a mean follow-up of 25.7±3.1 months, 37 patients (3.5%) died. When comparing study periods, statistically significant increase inpatients' complexity and VHD severity was noticed in Period 2, also translating into higher rate of referral to intervention (39.0% vs. 29.4% in Period 1; P=0.001). Finally, despite higher rate of elderly and frail patients, operative mortality was not jeopardized.
The present study reports a comprehensive assessment of the characteristics and outcomes achieved through an original HVC model. Standardization of access criteria supports the HVC improvement.
瓣膜性心脏病（VHD）需要优化的门诊管理，通常认为最好由专门的多学科团队（心脏瓣膜诊所[HVC]）提供。尽管临床指南提倡建立 HVC，并在许多中心建立了 HVC，但对真实世界的结果评估有限。因此，我们评估了在具有原始 HVC 模型的 6 年经验期间的表现、临床和管理结果。
通过查询本地数据库，发现 2015 年 1 月至 2020 年 10 月期间有 1047 例连续患者被收入 HVC。对所有患者进行管理和死亡率检查。在 HVC 活动开展 3 年后，为了提高适当性和效率，引入了准入优先标准。因此，将研究人群分为两个时间段亚组（准入标准引入前后）进行比较。
共有 1047 例连续患者被收入 HVC 构成研究人群；346 例（33%）被推荐进行侵入性治疗。平均随访 25.7±3.1 个月后，37 例（3.5%）患者死亡。在比较研究期间时，发现第 2 期患者的复杂性和 VHD 严重程度显著增加，也导致转诊至介入治疗的比例更高（39.0%比第 1 期的 29.4%；P=0.001）。最后，尽管老年和体弱患者的比例较高，但手术死亡率并未受到影响。
本研究报告了通过原始 HVC 模型的特点和结果的综合评估。准入标准的标准化支持 HVC 的改进。
