Impact of a Clinical Valve Coordinator on Hospital Length of Stay and Patient Outcomes: Results From the BENCHMARK Registry

BACKGROUND: Transcatheter aortic valve implantation (TAVI) treatment pathways can be supported by a dedicated clinical valve coordinator (CVC), enhancing their efficiency. We aimed to evaluate the impact of a CVC in managing the treatment pathway of patients undergoing TAVI across Europe before and after implementing 8 Benchmark best practices.

METHODS: The BENCHMARK registry (ClinicalTrials NCT04579445) was a multicenter international study of patients with severe symptomatic aortic stenosis undergoing TAVI with balloon-expandable valves across 28 European centers. Primary outcomes were hospital and intensive care length of stay (LoS). The secondary outcome was 30-day patient safety.

RESULTS: Of 2323 patients, 1262 were treated at centers without a pre-existing CVC and 1061 at centers with a pre-existing CVC; propensity matching resulted in 891 matched pairs. The total procedural time was significantly reduced in both groups (p < 0.001) after implementing Benchmark best practices. Hospital LoS was lower before Benchmark when a CVC was present and was significantly shorter in both groups following implementation (p < 0.001), as was the critical care LoS (p < 0.001). The presence of a CVC did not affect safety outcomes but was associated with a reduced risk of major vascular bleeding when combined with Benchmark best practices. Patient satisfaction was higher in centers with a pre-existing CVC (p < 0.001).

CONCLUSIONS: The addition of a CVC to the multidisciplinary team and their sustained contributions to processes of care align with the implementation of Benchmark practices, significantly decrease the health service requirements of TAVI patients, and are associated with improved patient-reported experiences.