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Original research
Differences in the presentation and management of patients with severe aortic stenosis in different European centres
  1. Matthias Lutz1,
  2. David Messika-Zeitoun2,
  3. Tanja K Rudolph3,
  4. Eberhard Schulz4,
  5. Jeetendra Thambyrajah5,
  6. Guy Lloyd6,
  7. Alexander Lauten7,
  8. Norbert Frey1,
  9. Jana Kurucova8,
  10. Martin Thoenes9,
  11. Cornelia Deutsch10,
  12. Peter Bramlage10 and
  13. Richard Paul Steeds11
  1. 1Department of Cardiology and Angiology, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany
  2. 2Department of Cardiology, University of Ottawa Heart Institue, Ottawa, Ontario, Canada
  3. 3Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
  4. 4Department of Cardiology, AKH Celle, Celle, Germany
  5. 5Department of Cardiology, James Cook University Hospital, Middlesbrough, UK
  6. 6Department of Cardiology, St Bartholomew's Hospital, London, UK
  7. 7Department of Cardiology, HELIOS Klinikum Erfurt, Erfurt, Germany
  8. 8Edwards Lifesciences, Irvine, California, USA
  9. 9Edwards Lifesciences, Nyon, Switzerland
  10. 10Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
  11. 11Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
  1. Correspondence to Dr Peter Bramlage; submission{at}


Background An investigation into differences in the management and treatment of severe aortic stenosis (AS) between Germany, France and the UK may allow benchmarking of the different healthcare systems and identification of levers for improvement.

Methods Patients with a diagnosis of severe AS under management at centres within the IMPULSE and IMPULSE enhanced registries were eligible.

Results Data were collected from 2052 patients (795 Germany; 542 France; 715 UK). Patients in Germany were older (79.8 years), often symptomatic (89.5%) and female (49.8%) and had a lower EF (53.8%) than patients in France and UK. Comorbidities were more common and they had a higher mean Euroscore II.

Aortic valve replacement (AVR) was planned within 3 months in 70.2%. This was higher (p<0.001) in Germany than France/ UK. Of those with planned AVR, 82.3% received it within 3 months with a gradual decline (Germany>France> UK; p<0.001). In 253 patients, AVR was not performed, despite planned. Germany had a strong transcatheter aortic valve implantation (TAVI) preference (83.2%) versus France/ UK (p<0.001). Waiting time for TAVI was shorter in Germany (24.9 days) and France (19.5 days) than UK (40.3 days).

Symptomatic patients were scheduled for an AVR in 79.4% (Germany> France> UK; p<0.001) and performed in 83.6% with a TAVI preference (73.1%). 20.4% of the asymptomatic patients were intervened.

Conclusion Patients in Germany had more advanced disease. The rate of intervention within 3 months after diagnosis was startlingly low in the UK. Asymptomatic patients without a formal indication often underwent an intervention in Germany and France.

  • surgery-valve
  • percutaneous valve therapy
  • aortic valve disease
  • quality of care and outcomes

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  • Twitter @MJLutz, @Richard.Steeds

  • Contributors NF, RPS, DM-Z, JK, MT and PB were involved in the conception and design of the study. ML and PB drafted the manuscript and all other authors revised the article for important intellectual content. All authors gave final approval of the version published.

  • Funding This work was supported by a research grant provided by Edwards Lifesciences (Nyon, Switzerland) to the Sponsor, the Institute for Pharmacology and Preventive Medicine (IPPMed, Cloppenburg, Germany).

  • Competing interests PB has received research funding for the present project and honoraria for consultancy from Edwards Lifesciences. NF, RPS and DM-Z have received honoraria for advisory board meetings and TKR speakers’ honoraria from Edwards Lifesciences. The institutions of these three and those of the remaining authors representing study centers have received funding for employing a study nurse.

  • Patient consent for publication Not required.

  • Ethics approval The study was carried out in accordance with the Declaration of Helsinki and was approved by the independent ethics review board at each participating institution. Patient informed consent was obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request from the corresponding author.

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