Timely Treatment of Severe Aortic Stenosis Model Share Utilizing Data Collected in American Heart Association's (AHA) Target: Aortic Stenosis Registry Pilot Program

According to Journal of the American Heart Association (AHA), 2021, less than 50% of severe aortic stenosis (AS) patients receive treatment within one year of symptom onset. In 2020, the CV Registry department accepted an invitation from AHA to join a learning collaborative focused on creating a registry tool to measure timely diagnosis and treatment of patients with severe aortic stenosis. The primary goals of this initiative are to identify barriers to treatment, and measure timely diagnosis and treatment of patient with severe aortic stenosis in order to improve patients outcomes. Target: Aortic Stenosis Registry data from 2020- 2023 demonstrated that our Structural Heart Clinic was able to meet AHA's registry benchmark of 75% or greater in year 2021-2023 for the Timely Treatment Measure (treatment with TAVR or SAVR within 90 days from severe aortic stenosis diagnosis by echo). During this period of time the valve clinic was able to improve treatment times by hiring a new Structural Heart Coordinator, adding an Operations Manager, created tableau reports to identify echoes of patients with severe aortic stenosis without a referral to the valve clinic, and implementing an outreach process to ordering providers regarding symptomatic status of identified aortic stenosis patients. The valve clinic also created same day imaging and diagnosis testing appointments for our non-local patients to shorter time from diagnosis to treatment. In conclusion, investing in high quality support staff and building collaborative multidisciplinary care teams contributes to best care practices. Utilizing protocols and data reports to identify gaps in patient care process promotes timely treatment of patients. Also, streamlining appointments provides efficiency and a patient-centered healthcare experience.

Timely Treatment for Severe Aortic Stenosis Phase 1: Model Share Terreal Rogers, Anwar Tandar, Sara Pereira, Satvik Ramakrishna, Jennifer Burgi, Kalie Christensen, Joe Perry Background & Rationale • • • <50% of severe aortic stenosis (AS) patients receive treatment within one year of symptom onset.* University of Utah Health is a 430-bed academic medical center that serves a large area within the Mountain West. Structural Heart Clinic sees 306 patients/year → 2021-2023: Performed an average of 156 Transthoracic Aortic Valve Repairs (TAVR)/year and 69 Surgical Aortic Valve Repairs (SAVR)/year → Out-of-state referrals account for 38% of patient population Results Target: AS findings, based on random sampling to include 15% of severe AS and 5% of moderate AS per echo parameters: • In four years, 2020 to 2023, 58 patients in Target: AS registry achieved class I indication for AVR. • 2020- 11 of 17 (64%) received valve replacement within 90 days of class I indication identification. • 2023- 12 of 12 (100%) received valve replacement within 90 days of class I indication identification. Percentage of U of U sample patients with a class I indication for AVR who receive definitive treatment (SAVR or TAVI) within 90 days of initial diagnosis Conclusion & Peer Suggestions • Investing in high quality support staff and building collaborative multidisciplinary care teams contributes to best care practices. • Utilizing protocols and data reports to identify gaps in patient care process promotes timely treatment of patients. • Streamlining appointments provides efficiency and a patient-centered healthcare experience. *Brennan et al., (Journal of the American Heart Association, 2021) Structural Heart Team Actions • • • • • 2012: Multi-disciplinary valve team initiated. 2022: Hired new structural heart coordinator and added Operations Manager. 2022: Tableau reports created from echo data to highlight potential but un-referred candidates for valve clinic. 2023: Outreach to ordering providers regarding symptomatic status of identified AS patients. For non-local patients → same day appointments for echocardiogram and CTA followed by valve clinic visit. Dr. Sara Pereira (CT Surgeon, Co-Director) Dr. Anwar Tandar (Structural Cardiologist, Co-Director) Dr. Satvik Ramakrishna (Echo Lab Director) Structural Heart Champions Jennifer Burgi, MBA, MHA Structural Heart Coordinator Email: [e-mail] Phone: [phone] Structural Heart Team Members Disclaimer: The authors identified above are part of the University of Utah Health. This content reflects their own independent analysis and does not represent findings from the AHA Get With The Guidelines® national program. The materials are for educational purposes only, and do not constitute an endorsement by the AHA.