As in so many areas of healthcare, increased demand for TAVI procedures for patients with severe aortic stenosis (AS) has not been matched with a proportional increase in available resources in recent years. This whitepaper captures the findings of a recent advisory board meeting which explored the opportunity to increase the capacity for TAVI procedures within the NHS through truly integrated care and improved referral pathways.

Changing care pathways enhances health and quality of life, whilst reducing burden on the health and social care system. This video describes an example of how this can be achieved and was used to lobby for a change in policy.

Increasing numbers of patients with AS are waiting for TAVI in the UK and this situation will have worsened after the Covid-19 pandemic. A number of these patients will require pacing, but different centres across the UK have different approaches in terms of patient management and technology choices, and there is significant variation in the rate of post-TAVI PPI across centres. A unified strategy is required to ensure that patients receive a consistent level of care, with the aim of reducing waiting times to access TAVI, reducing PPI where possible and optimising patient outcomes.

PPI post-TAVI increases the hospital mean length of stay (LOS), which presents a capacity issue, especially in light of the Covid-19 pandemic, so it is important that a clearly defined and integrated ‘best practice TAVI pathway’ is developed with a standardised protocol for PPI embedded within it.

This advisory board meeting highlighted that there is much scope to increase the capacity for TAVI procedures within the NHS by the introduction of true integrated care, which could improve the referral pathway for patients and increase the efficiency of tertiary centre multidisciplinary teams.

The story of Malcolm’s experience of a heart failure care pathway

In this scenario using a fictional patient, Malcolm, we examine high risk heart failure caused by aortic stenosis within a comorbidities care pathway, comparing a suboptimal clinical scenario against an ideal pathway.

At each stage we have modelled the costs of care, not only financially to the local health economy, but also the cost impact on the patient and their family’s experience.

View our interview with Dr Clare Appleby, consultant cardiologist at the Liverpool Heart and Chest Hospital

Our healthcare consultant Sarah Shield talks to Dr Appleby about some of the issues raised in the whitepaper, particularly around the increased demand, pressures on capacity and the need to triage and manage patients that may require pacing.