# Implementation of an integrated care pathway for severe aortic stenosis: a prospective cohort study of clinical profiles, safety, and outcomes

## TL;DR

This study examines how an integrated care pathway improves outcomes for patients with severe aortic stenosis by comparing treatment strategies and early survival rates.

## Contribution

The study provides real-world evidence on the effectiveness of an integrated care pathway for managing severe aortic stenosis.

## Key findings

- TAVR and SAVR had high device success and low early mortality compared to conservative management.
- TAVR was associated with higher pacemaker implantation and vascular complications, while SAVR had more reoperations and atrial fibrillation.
- Prehabilitation was common, but postprocedural cardiac rehabilitation was underutilized.

## Abstract

Severe aortic stenosis (AS) management increasingly requires multidisciplinary coordination across diagnostic, interventional, and rehabilitation stages. Integrated care pathways (ICPs) supported by structured data systems may improve safety and outcomes, but real-world evidence in AS remains limited. We aimed to characterize a contemporary cohort of patients with severe AS managed within an ICP at a tertiary hospital, comparing profiles and outcomes by treatment strategy, and to describe diagnostic procedures and the implementation of cardiac rehabilitation (CR) interventions embedded in the pathway.

Prospective observational study of all consecutive patients with AS evaluated by a multidisciplinary heart team between 2018 and 2022. Baseline characteristics and frailty, diagnostic tests, CR interventions, procedural details, and outcomes were collected via an interoperable data management platform and compared across treatment groups: surgical (SAVR) or transcatheter (TAVR) valve replacement, or conservative management. Early survival was assessed using Kaplan–Meier analysis with log-rank testing.

Among 984 patients (median age 78 years, 42% women), 43.9% underwent SAVR, 49.8% TAVR, and 6.3% were managed conservatively. TAVR and conservative groups were older, frailer, and had higher comorbidity. Device success at 30 days was high (≈91%), with periprocedural death at 2.5% for interventions, vs. 9.7% early mortality for conservative management (p < 0.001). Early survival differed significantly (log-rank p = 0.004). TAVR had higher permanent pacemaker implantation (21.7% vs. 7.4% for SAVR, p < 0.001) and major vascular complications (4.1% vs. 0.2%, p < 0.001), while SAVR had more reoperations (8.3% vs. 0.2%, p < 0.001) and atrial fibrillation (18.9% vs. 10.1%, p = 0.001). Prehabilitation was implemented in 64.6% of candidates, while postprocedural CR remained underutilized (11.3%).

Integrated care for a cohort of patients with AS, supported by structured data management, enabled comprehensive profiling, systematic outcome monitoring, and identification of improvement areas. Both SAVR and TAVR achieved high success with low early mortality, while conservative management had poor survival.