title: Quality of care assessment and improvement in aortic stenosis - rationale and design of a multicentre registry (IMPULSE).
abstract: Severe aortic stenosis (AS) is a common, serious valve disease in which no effective medical therapy is available and, if not treated by intervention, has a 5-year survival of only 40-60%. Despite the availability of guidelines supporting the effective use of surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) to treat the majority of these patients, adherence to these guidelines in clinical practice is still unsatisfactory. Several recent studies have emphasised the necessity for improved communication between multidisciplinary teams, with the aim to ensure that severe AS patients receive appropriate treatment.
  
  
  
  IMPULSE is a prospective, multicentre, European registry designed to gather data over 12 months on the treatment decisions made by referring physicians for patients newly diagnosed with severe AS. Each patient has a follow-up of 3 months. The study will consist of two observational phases to assess the appropriateness and rate of referral based on current guidelines prior to and after an interventional phase aiming to determine whether a simple quality of care intervention improves patient management.
  
  
  
  Data will be analysed firstly, to determine the appropriateness of treatment decisions for the management of severe AS in current European clinical practice, and secondly, to evaluate the effectiveness of facilitated data relay from a designated echocardiography department nurse to the referring physician early after diagnosis in improving quality of care. Additionally, variables will be identified that are associated with inappropriate decision-making. Collectively, the aim will be to design a clinical pathway that will improve the timely management of patients with newly diagnosed severe AS.
authors.affiliation: Department of Cardiology and Angiology, University of Kiel, Kiel, Germany. norbert.frey@uksh.de.
authors.forename: Norbert
authors.initials: N
authors.lastname: Frey
authors.affiliation: Queen Elizabeth Hospital and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Steeds
authors.affiliation: Hospital de Sant Pau, Cardiology Unit, University of Barcelona, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Serra
authors.affiliation: Cardiology Department I, University Clinic Mainz, Mainz, Germany.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Schulz
authors.affiliation: Clinic for Cardiology, Angiology, and Pneumology and Intensive Care Medicine, Heart Center of the University Clinic Cologne, Cologne, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Baldus
authors.affiliation: Department of Cardiology and Angiology, University of Kiel, Kiel, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Lutz
authors.affiliation: Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Pohlmann
authors.affiliation: Edwards Lifesciences, Prague, Czech Republic.
authors.forename: Jana
authors.initials: J
authors.lastname: Kurucova
authors.affiliation: Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Bramlage
authors.affiliation: Department of Cardiology, Bichat Hospital, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Messika-Zeitoun
mesh_terms: D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D000066491:Clinical Decision-Making; D005060:Europe; D019983:Guideline Adherence / Q000592:standards; D006302:Health Services Research; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards; D017064:Process Assessment, Health Care / Q000592:standards*; D011446:Prospective Studies; D058996:Quality Improvement / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D012017:Referral and Consultation / Q000592:standards; D012042:Registries; D012107:Research Design; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000592:standards*; D016896:Treatment Outcome
keywords: Aortic stenosis; Facilitated data relay; Quality of care; Surgical aortic valve replacement; Transcatheter aortic valve implantation