Best Practice Recommendations for Optimizing Care in Structural Heart Programs: Planning Efficient and Resource Leveraging Systems (PEARLS)

ABSTRACT

The COVID19 pandemic brought unprecedented disruption to healthcare. Staggering morbidity, mortality, and economic losses prompted the review and refinement of care for structural heart disease (SHD). To mitigate negative impacts in the face of crisis or capacity constraints, this paper offers best practice recommendations for Planning Efficient and Resource Leveraging Systems (PEARLS) in structural heart programs. A systematic assessment is recommended for hospital capacity, Heart Team roles and functions, and patient and procedural risks associated with increased resource utilization. Strategies, tactics, and pathways are provided for the delivery of patient-centered, efficient and resource-leveraging care from referral to follow-up. Through the optimal use of capacity and resources, paired with dynamic triage, forecasting, and surveillance, Heart Teams may aspire to plan and implement an optimized system of care for SHD.

Abbreviations: AS: aortic stenosis; ASD: atrioseptal defect; COVID19: Coronavirus disease 19; LAAO: left atrial appendage occlusion; MI: myocardial infarction; MR: mitral regurgitation; PFO: patent foramen ovale; PVL: paravalvular leak; SHD: structural heart disease; SAVR: surgical aortic valve replacement; SDM: shared decision-making; TAVR: transcatheter aortic valve replacement; TMVr: transcatheter mitral valve repair; TMVR: transcatheter mitral valve replacement; TEE: transesophageal echocardiography; TTE: transthoracic echocardiography.

KEYWORDS:

• COVID19, heart valve diseases
• transcatheter aortic valve replacement
• transcatheter mitral valve repair
• structural heart
• triage
• continuum of care
• capacity building
• patient care management

Disclosure statement

EM Perpetua has received consulting/speaker’s bureau honoraria from Edwards Lifesciences and Abbott Vascular.

KA Guibone has received consulting/speaker’s bureau honoraria from Medtronic.

PA Keegan has received consulting/speaker’s bureau honoraria from Edwards Lifesciences and Abbott Vascular.

J Michaels is employed by the American College of Cardiology.

R Palmer has received consulting/speaker’s bureau honoraria from Edwards Lifesciences.

MK Speight has received consulting/speaker’s bureau honoraria from Edwards Lifesciences.

All other authors have no conflicts of interest to report.

Additional information

Funding

The authors report no funding in support of this paper.