Reducing Delays in Aortic Stenosis Treatment: A Clinical Audit of the Transcatheter Aortic Valve Implantation (TAVI) Pathway and Quality Improvement Initiatives

TL;DR

This study audits the TAVI treatment pathway for aortic stenosis and finds significant delays, leading to a quality improvement plan to reduce waiting times and improve patient outcomes.

Contribution

The paper introduces a quality improvement action plan targeting delays in the TAVI pathway through new clinic and scheduling strategies.

Findings

The average total referral-to-TAVI time was 155 days, exceeding the 126-day benchmark.

Major delays occurred between clinic and MDT (mean 56 days) and MDT-to-procedure (mean 64 days).

Two patients died while awaiting TAVI, and one died within 30 days post-procedure.

Abstract

Background

Severe aortic stenosis (AS) is a prevalent and life-threatening condition in older adults. Timely valve replacement, either surgical or transcatheter, significantly improves survival. This audit evaluated our transcatheter aortic valve implantation (TAVI) pathway to identify delays and implement targeted quality improvements.

Methods

A retrospective audit of 29 consecutive patients with severe symptomatic AS referred for TAVI at a tertiary cardiac centre was conducted. Data on three key intervals, namely, referral-to-clinic, clinic-to-multidisciplinary team (MDT) decision, and MDT-to-procedure, were extracted from hospital records. Compliance with predefined timing targets (≤6 weeks per interval, ≤18 weeks total) was assessed, along with wait-list and 30-day mortality. Descriptive statistics summarized waiting times and compliance rates.

Results

The mean age was 76.3±9.8 with a median of 79; 18 (62%) were male, and 25 (86%) presented in New York Heart Association (NYHA) class III/IV heart failure. The mean total referral-to-TAVI time was 155±24 days (median 155), exceeding the 126-day benchmark; only three (10%) received treatment within 18 weeks. Referral-to-clinic targets were largely met in 23 (79%) patients, but major delays occurred between clinic and MDT (mean 56 days) and MDT-to-procedure (mean 64 days). Two (6.9%) patients died while awaiting TAVI, and among the 27 who underwent TAVI, one (3.7%) died within 30 days.

Conclusions

This audit revealed substantial delays in the TAVI pathway, primarily due to diagnostic and scheduling bottlenecks, resulting in prolonged waiting times and avoidable adverse outcomes. A quality improvement action plan, including a rapid-access valve clinic, one-stop investigations, increased procedural capacity, and active wait-list monitoring, has been implemented. Re-audit will evaluate the impact on reducing waiting times and improving patient outcomes.

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