Heart surgery delays will cost lives, warns research

Urgent action is needed to clear the backlog of people with a common heart condition who are waiting for lifesaving treatment, according to research supported by the British Heart Foundation which was published in BMJ Open. The researchers have warned that a lack of action could result in thousands of people dying while waiting for treatment.

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

Aortic stenosis develops when the heart’s aortic valve becomes narrowed, restricting blood flow out of the heart. Prompt treatment is vital for people diagnosed with severe aortic stenosis, as around 50 per cent will die within two years of symptoms beginning.

Now, an international team of researchers has modelled the impact that increasing treatment capacity and using a quicker, less invasive treatment option would have on waiting lists. Even in the best-case scenario, they found that the waiting list would take nearly a year to clear and over 700 people would die while waiting for treatment.

The traditional treatment for aortic stenosis involves replacing the narrowed valve, most commonly through open heart surgery (a surgical aortic valve replacement, SAVR). However, a newer keyhole procedure called a transcatheter aortic valve implantation (TAVI) is increasingly being used and is now recommended for patients aged 75 and over.

The researchers investigated the impact that increasing treatment capacity and converting a proportion of operations to the quicker TAVI procedure would have on the backlog. They looked at how long it would take to clear the backlog and the number of people who would die while waiting for treatment.

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

The team say they want to see greater collaboration at local and national levels to agree the changes needed that can ensure that people with severe aortic stenosis receive lifesaving treatment as quickly as possible.

Professor Mamas Mamas, Professor of Cardiology at Keele University and consultant cardiologist at University Hospitals of North Midlands NHS Trust, was one of the leading 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 per cent would represent one or two additional TAVI procedures each week per centre. We think that with local and national collaboration this increase is achievable. Furthermore, we have created an algorithm that NHS Trusts can use to work out the best approach locally.

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

“Doing nothing is simply not an option. If we continue as we are currently thousands of people will die from untreated aortic stenosis.”

Dr Sonya Babu-Narayan, Associate Medical Director at the British Heart Foundation and consultant cardiologist, said: “We welcome the use of innovative cardiovascular procedures that can reduce the need for open heart surgery where appropriate and where their use will provide the greatest benefit to patients.

“But, as this modelling study shows, even increased use of this quicker and less invasive procedure won’t be enough to overcome the impact of Covid-19 related delays and stop people with aortic stenosis dying while waiting for treatment.

“Cardiac care can’t wait. The NHS desperately needs additional resources to help it tackle the backlog of care and ensure that heart patients receive the treatment and care they need.”

This research was part funded by the EPSRC Cambridge Centre for Mathematics of Information in Healthcare and supported by the NIHR Cambridge BRC.