Stickels, C, Nadarajah, R, Gale, C, Jiang, H, Sharkey, K, Gibbison, B, Holliman, N, Lombardo, S, Schewe, L, Sommacal, M, Sun, L, Weir-McCall, J, Cheema, K, Rudd, J, Mamas, MA ORCID: https://orcid.org/0000-0001-9241-8890 and Erhun, F (2021) Aortic stenosis post-COVID-19: A mathematical model on waiting lists and mortality. medRxiv.

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2021.11.11.21266212v1.full.pdf - Accepted Version

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Abstract

<h4>Objectives</h4> To provide estimates for how different treatment pathways for the management of severe aortic stenosis (AS) may affect NHS England waiting list duration and associated mortality. <h4>Design</h4> We constructed a mathematical model of the excess waiting list and found the closed-form analytic solution to that model. From published data, we calculated estimates for how the following strategies may affect the time to clear the backlog of patients waiting for treatment and the associated waiting list mortality. <h4>Interventions</h4> 1) increasing the capacity for the treatment of severe AS, 2) converting proportions of cases from surgery to transcatheter aortic valve implantation, and 3) a combination of these two. <h4>Results</h4> In a capacitated system, clearing the backlog by returning to pre-COVID-19 capacity is not possible. A conversion rate of 50% would clear the backlog within 666 (95% CI, 533–848) days with 1419 (95% CI, 597–2189) deaths whilst waiting during this time. A 20% capacity increase would require 535 (95% CI, 434–666) days, with an associated mortality of 1172 (95% CI, 466–1859). A combination of converting 40% cases and increasing capacity by 20% would clear the backlog within a year (343 (95% CI, 281–410) days) with 784 (95% CI, 292–1324) deaths whilst awaiting treatment. <h4>Conclusion</h4> A strategy change to the management of severe AS is required to reduce the NHS backlog and waiting list deaths during the post-COVID-19 ‘recovery’ period. However, plausible adaptations will still incur a substantial wait and many hundreds dying without treatment.

Item Type: Article
Additional Information: This is a preprint uploaded to medRxiv, this version which has not undergone peer review or publication will be updated when appropriate when/if accepted for publication. Any copyrights and relevant information can be found on the publisher website at; 10.1101/2021.11.11.21266212
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
R Medicine > RD Surgery > RD32 Operative surgery. Technique of surgical operations
Depositing User: Symplectic
Date Deposited: 26 Jan 2022 10:15
Last Modified: 26 Jan 2022 10:15
URI: https://eprints.keele.ac.uk/id/eprint/10527

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