Heart surgery

Heart surgery delays will cost lives, research warns

Urgent action is needed to clear the backlog of people with common heart disease waiting for lifesaving treatment, according to research we supported and published today in BMJ Open. Researchers have warned that a lack of action could lead to the death of thousands of people while waiting for treatment.

The Covid-19 pandemic has led to the postponement of thousands of cardiac procedures and record waiting lists. Previous work estimated that 4,989 people in England with severe aortic stenosis missed life-saving treatment between March and November 2020.

Aortic stenosis develops when the aortic valve of the heart narrows, which restricts blood flow out of the heart. Prompt treatment is vital for people diagnosed with severe aortic stenosis, as around 50% will die within two years of the onset of symptoms.

Best case scenario

Researchers studied the impact that increasing processing capacity and converting some operations to the faster TAVI procedure would have on the backlog. They looked at how long it would take to clear the backlog and how many people would die while waiting for treatment.

They found that the best and most feasible option involved a combination of increasing capacity by 20% and converting 40% of procedures from SAVR to TAVI. This would clear the backlog in 343 days with 784 deaths while people wait for treatment.

Greater collaboration needed

The team says they want to see greater collaboration locally and nationally to agree on needed changes that can ensure people with severe aortic stenosis receive life-saving treatment as quickly as possible.

Professor Mamas Mamas, Professor of Cardiology at Keele University and Consultant Cardiologist at North Midlands NHS Trust University Hospitals, was one of the lead researchers in the study. He said:

“Before the pandemic, around 13,500 SAVR and TAVI procedures were performed each year across the UK. Increasing capacity by 20% would represent one or two additional TAVI procedures per week per center. We believe that with local and national collaboration, this increase is achievable. Additionally, we have created an algorithm that NHS Trusts can use to find the best approach locally.

“Since November 2020 the UK has been hit by new waves of Covid-19 which have resulted in extreme pressure on the NHS and further delays in treatment. We expect the number of people waiting for treatment in recent months to be even higher than the number we used in our study.

“Doing nothing is just not an option. If we continue as we are now, thousands of people will die from untreated aortic stenosis.

Dr. Sonya Babu-Narayan, our Associate Medical Director and Consultant Cardiologist, said:

“We welcome the use of innovative cardiovascular procedures that can reduce the need for open-heart surgery, if needed, and where their use will provide the greatest benefit to patients.

“But, as this modeling study shows, even increased use of this faster, less invasive procedure will not be enough to overcome the impact of Covid-19-related delays and prevent people with aortic stenosis from dying in the first place.” waiting for treatment.

“Cardiac care cannot wait. The NHS desperately needs extra resources to help it deal with the backlog of care and ensure heart patients get the treatment and care they need.

This research was partially funded by the EPSRC Cambridge Center for Mathematics of Information in Healthcare.