Valvular & structural heart diseaseMeta-analysis
Delay and attrition in severe aortic stenosis: a four-checkpoint systematic review of pathway bottlenecks and interventions
- systematic review with narrative synthesis
- four-checkpoint framework
Authors' conclusion
Severe AS care is characterized by measurable delay and attrition across multiple post-diagnostic transitions, while pre-echocardiographic recognition remains an important evidence gap. A four-checkpoint framework may support benchmarking and targeted pathway improvement through structured reporting, electronic referral prompts, risk-based triage, and decentralized workflows.
Study context
- Population
- Adults with severe aortic stenosis (AS)patients represented in the synthesis, 19 studies
- Participants
- ∼52,000 adults
Pooled result
As reported in the abstract
- no included study providing severe-AS-specific data before echocardiography
Further pooled results
Missed or delayed recognition at echocardiographic detection
- concentrated in low-gradient phenotypes and women
Severe-AS detection with an artificial-intelligence-assisted alert system
- increased severe-AS detection from
- 2.4% to 4.1%
Under treatment after diagnosis; non-cardiology ordering of the diagnostic echocardiogram
- under treatment persisted despite guideline indications
- non-cardiology ordering associated with lower early follow-up or AVR and higher mortality
AVR rates with electronic provider notification · 1-year
- increased 1-year AVR rates from
- 37.2% to 48.2%
- largest observed effects in women, patients older than 80 years, and inpatient echocardiography
Wait-list mortality at procedural access
- wait-list mortality
- ∼4.5-5.8%
- deaths occurring early after referral
Risk-based triage and decentralized pre-procedural work-up
- decentralized pre-procedural work-up shortened referral-to-TAVI time from
- 126 to 32 days
- Risk-based triage reduced modelled wait-list mortality
Original publication
Summarised from the published abstract; every number is checked against it