Preliminary effectiveness of the whole-life cycle management model for valvular heart disease at West China Hospital: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

RAN Zechao ^1,2 , WANG Yuqiang ^1,2 , HE Siyu ^1,2 , ZHONG Shitong ^1,2 , CAO Tingqian ³ , LIU Xiang ⁴ , LUO Zeruxin ⁵ , LIU Lulu ¹ , SHI Jun ¹ ,  GUO Yingqiang ^1,2

1. Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. Integrated Care Management Center, Outpatient Department, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
4. Information Technology Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
5. Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding?author：

GUO Yingqiang, Email: drguoyq@wchscu.cn

Keywords：

Valvular heart disease; whole-life cycle management model; disease management specialist; health services

DOI：

10.7507/1007-4848.202503026

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Objective To propose a whole-life cycle management model for valvular heart disease (VHD), systematically elucidate its underlying logic and implementation pathways, and concurrently review and analyze its preliminary application outcomes. Methods Since 2020, West China Hospital of Sichuan University has established a management system encompassing "assessment-decision-intervention-follow-up", including: (1) a risk-stratified, tiered management pathway; (2) six core functions ("promotion, screening, prevention, diagnosis, treatment, and rehabilitation") coordinated by disease-specific managers; (3) an intelligent decision support information platform; and (4) a collaborative network of multidisciplinary teams and regional academic alliances. To evaluate the effectiveness of this management model, we retrospectively included three cohorts: (1) the population screened by echocardiography from 2020 to 2024, analyzing the detection rate of aortic valve disease and risk stratification; (2) patients enrolled in the whole-life cycle management from April 2021 to December 2024, assessing follow-up outcomes, hospital satisfaction, and changes in quality of life; (3) patients who underwent transcatheter aortic valve replacement (TAVR) from January 2022 to January 2024, evaluating the one-year all-cause mortality rate, perioperative complications, and improvements in New York Heart Association (NYHA) classification. Results Between 2020 and 2024, a total of 583 874 individuals underwent echocardiographic screening. A total of 48 089 patients with aortic valve disease were identified, including 3 401 (7.1%) high-risk patients, 18 657 (38.8%) moderate-risk patients, and 26 031 (54.1%) low-risk patients. Among them, 2 417 patients were enrolled in whole-life cycle management. Patient satisfaction scores showed a yearly increase, rising from 73.89 points before 2020 to 93.74 points in 2024. The 1-year mortality rate in the TAVR cohort decreased to 5.3%, significantly lower than the 8.2% observed under early standard management between 2014 and 2019 (P<0.01). Conclusion Through process optimization and resource integration, the VHD whole-life cycle management model has demonstrated significant effectiveness in standardizing diagnostic and follow-up procedures, enhancing patient satisfaction and quality of life, and reducing mortality. These outcomes highlight its practical value for broader implementation in China.

Citation： RAN Zechao, WANG Yuqiang, HE Siyu, ZHONG Shitong, CAO Tingqian, LIU Xiang, LUO Zeruxin, LIU Lulu, SHI Jun, GUO Yingqiang. Preliminary effectiveness of the whole-life cycle management model for valvular heart disease at West China Hospital: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(7): 968-976. doi: 10.7507/1007-4848.202503026 Copy

1.	中華醫學會心血管病學分會心血管影像學組, 北京醫學會心血管病學會影像學組. 中國成人心臟瓣膜病超聲心動圖規范化檢查專家共識. 中國循環雜志, 2021, 36(2): 109-125.Division of Cardiovascular Imaging, Chinese Society of Cardiology, Chinese Medical Association, Imaging Group, Cardiovascular Department, Beijing Medical Association. Expert consensus for standard assessment by echocardiography in Chinese adults with valvular heart disease. Chin Circ J, 2021, 36(2): 109-125.
2.	Yang Y, Wang Z, Chen Z, et al. Current status and etiology of valvular heart disease in China: A population-based survey. BMC Cardiovasc Disord, 2021, 21(1): 339.
3.	Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: A population-based study. Lancet, 2006, 368(9540): 1005-1011.
4.	Lin J, Yang D, Zhao X, et al. The action logic of the older adults about health-seeking in south rural China. BMC Public Health, 2023, 23(1): 2487.
5.	Xu H, Liu Q, Cao K, et al. Distribution, characteristics, and management of older patients with valvular heart disease in China: China-DVD study. JACC Asia, 2022, 2(3): 354-365.
6.	Cheng TO. How much of the recent decline in rheumatic heart disease in China can be explained by changes in cardiovascular risk factors? Int J Cardiol, 2009, 132(3): 300-302.
7.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e72-e227.
8.	Mengi S, Januzzi JL, Cavalcante JL, et al. Aortic stenosis, heart failure, and aortic valve replacement. JAMA Cardiol, 2024, 9(12): 1159-1168.
9.	Wang Y, Cao T, Liu X, et al. A new benchmark for modern management of valvular heart disease: The whole-life cycle management system. JACC Asia, 2025, 5(5): 609-632.
10.	Gaede L, Di Bartolomeo R, van der Kley F, et al. Aortic valve stenosis: What do people know? A heart valve disease awareness survey of over 8, 800 people aged 60 or over. EuroIntervention, 2016, 12(7): 883-889.
11.	Guo W, Sylvia S, Umble K, et al. The competence of village clinicians in the diagnosis and treatment of heart disease in rural China: A nationally representative assessment. Lancet Reg Health West Pac, 2020, 2: 100026.
12.	Kodali SK, Velagapudi P, Hahn RT, et al. Valvular heart disease in patients ≥80 years of age. J Am Coll Cardiol, 2018, 71(18): 2058-2072.
13.	Zilberszac R, Lancellotti P, Gilon D, et al. Role of a heart valve clinic programme in the management of patients with aortic stenosis. Eur Heart J Cardiovasc Imaging, 2017, 18(2): 138-144.
14.	Tu WJ, Xue Y, Nie D. The prevalence and treatment of diabetes in China from 2013 to 2018. JAMA, 2022, 327(17): 1706.
15.	Alaour B, Menexi C, Shah BN. Clinical and echocardiographic follow-up of patients following surgical heart valve repair or replacement: A tertiary centre experience. Echo Res Pract, 2018, 5(3): 113-119.
16.	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
17.	Liu F, Panagiotakos D. Real-world data: A brief review of the methods, applications, challenges and opportunities. BMC Med Res Methodol, 2022, 22(1): 287.
18.	Praz F, Beyersdorf F, Haugaa K, et al. Valvular heart disease: From mechanisms to management. Lancet, 2024, 403(10436): 1576-1589.
19.	Généreux P, Pibarot P, Redfors B, et al. Staging classification of aortic stenosis based on the extent of cardiac damage. Eur Heart J, 2017, 38(45): 3351-3358.
20.	Roselli C, Yu M, Nauffal V, et al. Genome-wide association study reveals novel genetic loci: A new polygenic risk score for mitral valve prolapse. Eur Heart J, 2022, 43(17): 1668-1680.
21.	Wood DA, Lauck SB, Cairns JA, et al. The vancouver 3M (multidisciplinary, multimodality, but minimalist) clinical pathway facilitates safe next-day discharge home at low-, medium-, and high-volume transfemoral transcatheter aortic valve replacement centers: The 3M TAVR study. JACC Cardiovasc Interv, 2019, 12(5): 459-469.
22.	Taggu W, Topham A, Hart L, et al. A cardiac sonographer led follow up clinic for heart valve disease. Int J Cardiol, 2009, 132(2): 240-243.
23.	Ionescu A, McKenzie C, Chambers JB. Are valve clinics a sound investment for the health service? A cost-effectiveness model and an automated tool for cost estimation. Open Heart, 2015, 2(1): e000275.
24.	Head SJ, Kaul S, Mack MJ, et al. The rationale for heart team decision-making for patients with stable, complex coronary artery disease. Eur Heart J, 2013, 34(32): 2510-2518.
25.	Luo D, Zhu X, Qiu X, et al. Healthcare preferences of chronic disease patients under China's hierarchical medical system: An empirical study of Tianjin's reform practice. Sci Rep, 2024, 14(1): 11631.
26.	劉若云, 劉然, 戴枚芳, 等. 評價全生命周期管理體系對經導管主動脈瓣置換術患者預后的影響. 中國介入心臟病學雜志, 2024, 32(6): 311-316.Liu RY, Liu R, Dai MF, et al. Evaluation of life cycle management system on patients' prognosis after transcatheter aortic valve replacement. Chin J Interv Cardiol, 2024, 32(6): 311-316.
27.	Frank D, Durand E, Lauck S, et al. A streamlined pathway for transcatheter aortic valve implantation: The BENCHMARK study. Eur Heart J, 2024, 45(21): 1904-1916.
28.	Pavone N, Burzotta F, Bruno P, et al. Heart valve critical pathway and heart valve clinic: Novel benchmarks for modern management of valvular heart disease. Crit Pathw Cardiol, 2021, 20(3): 126-133.
29.	Durand E, Beziau-Gasnier D, Michel M, et al. Reducing length of stay after transfemoral transcatheter aortic valve implantation: The FAST-TAVI Ⅱ trial. Eur Heart J, 2024, 45(11): 952-962.

1. 中華醫學會心血管病學分會心血管影像學組, 北京醫學會心血管病學會影像學組. 中國成人心臟瓣膜病超聲心動圖規范化檢查專家共識. 中國循環雜志, 2021, 36(2): 109-125.Division of Cardiovascular Imaging, Chinese Society of Cardiology, Chinese Medical Association, Imaging Group, Cardiovascular Department, Beijing Medical Association. Expert consensus for standard assessment by echocardiography in Chinese adults with valvular heart disease. Chin Circ J, 2021, 36(2): 109-125.
2. Yang Y, Wang Z, Chen Z, et al. Current status and etiology of valvular heart disease in China: A population-based survey. BMC Cardiovasc Disord, 2021, 21(1): 339.
3. Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: A population-based study. Lancet, 2006, 368(9540): 1005-1011.
4. Lin J, Yang D, Zhao X, et al. The action logic of the older adults about health-seeking in south rural China. BMC Public Health, 2023, 23(1): 2487.
5. Xu H, Liu Q, Cao K, et al. Distribution, characteristics, and management of older patients with valvular heart disease in China: China-DVD study. JACC Asia, 2022, 2(3): 354-365.
6. Cheng TO. How much of the recent decline in rheumatic heart disease in China can be explained by changes in cardiovascular risk factors? Int J Cardiol, 2009, 132(3): 300-302.
7. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e72-e227.
8. Mengi S, Januzzi JL, Cavalcante JL, et al. Aortic stenosis, heart failure, and aortic valve replacement. JAMA Cardiol, 2024, 9(12): 1159-1168.
9. Wang Y, Cao T, Liu X, et al. A new benchmark for modern management of valvular heart disease: The whole-life cycle management system. JACC Asia, 2025, 5(5): 609-632.
10. Gaede L, Di Bartolomeo R, van der Kley F, et al. Aortic valve stenosis: What do people know? A heart valve disease awareness survey of over 8, 800 people aged 60 or over. EuroIntervention, 2016, 12(7): 883-889.
11. Guo W, Sylvia S, Umble K, et al. The competence of village clinicians in the diagnosis and treatment of heart disease in rural China: A nationally representative assessment. Lancet Reg Health West Pac, 2020, 2: 100026.
12. Kodali SK, Velagapudi P, Hahn RT, et al. Valvular heart disease in patients ≥80 years of age. J Am Coll Cardiol, 2018, 71(18): 2058-2072.
13. Zilberszac R, Lancellotti P, Gilon D, et al. Role of a heart valve clinic programme in the management of patients with aortic stenosis. Eur Heart J Cardiovasc Imaging, 2017, 18(2): 138-144.
14. Tu WJ, Xue Y, Nie D. The prevalence and treatment of diabetes in China from 2013 to 2018. JAMA, 2022, 327(17): 1706.
15. Alaour B, Menexi C, Shah BN. Clinical and echocardiographic follow-up of patients following surgical heart valve repair or replacement: A tertiary centre experience. Echo Res Pract, 2018, 5(3): 113-119.
16. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
17. Liu F, Panagiotakos D. Real-world data: A brief review of the methods, applications, challenges and opportunities. BMC Med Res Methodol, 2022, 22(1): 287.
18. Praz F, Beyersdorf F, Haugaa K, et al. Valvular heart disease: From mechanisms to management. Lancet, 2024, 403(10436): 1576-1589.
19. Généreux P, Pibarot P, Redfors B, et al. Staging classification of aortic stenosis based on the extent of cardiac damage. Eur Heart J, 2017, 38(45): 3351-3358.
20. Roselli C, Yu M, Nauffal V, et al. Genome-wide association study reveals novel genetic loci: A new polygenic risk score for mitral valve prolapse. Eur Heart J, 2022, 43(17): 1668-1680.
21. Wood DA, Lauck SB, Cairns JA, et al. The vancouver 3M (multidisciplinary, multimodality, but minimalist) clinical pathway facilitates safe next-day discharge home at low-, medium-, and high-volume transfemoral transcatheter aortic valve replacement centers: The 3M TAVR study. JACC Cardiovasc Interv, 2019, 12(5): 459-469.
22. Taggu W, Topham A, Hart L, et al. A cardiac sonographer led follow up clinic for heart valve disease. Int J Cardiol, 2009, 132(2): 240-243.
23. Ionescu A, McKenzie C, Chambers JB. Are valve clinics a sound investment for the health service? A cost-effectiveness model and an automated tool for cost estimation. Open Heart, 2015, 2(1): e000275.
24. Head SJ, Kaul S, Mack MJ, et al. The rationale for heart team decision-making for patients with stable, complex coronary artery disease. Eur Heart J, 2013, 34(32): 2510-2518.
25. Luo D, Zhu X, Qiu X, et al. Healthcare preferences of chronic disease patients under China's hierarchical medical system: An empirical study of Tianjin's reform practice. Sci Rep, 2024, 14(1): 11631.
26. 劉若云, 劉然, 戴枚芳, 等. 評價全生命周期管理體系對經導管主動脈瓣置換術患者預后的影響. 中國介入心臟病學雜志, 2024, 32(6): 311-316.Liu RY, Liu R, Dai MF, et al. Evaluation of life cycle management system on patients' prognosis after transcatheter aortic valve replacement. Chin J Interv Cardiol, 2024, 32(6): 311-316.
27. Frank D, Durand E, Lauck S, et al. A streamlined pathway for transcatheter aortic valve implantation: The BENCHMARK study. Eur Heart J, 2024, 45(21): 1904-1916.
28. Pavone N, Burzotta F, Bruno P, et al. Heart valve critical pathway and heart valve clinic: Novel benchmarks for modern management of valvular heart disease. Crit Pathw Cardiol, 2021, 20(3): 126-133.
29. Durand E, Beziau-Gasnier D, Michel M, et al. Reducing length of stay after transfemoral transcatheter aortic valve implantation: The FAST-TAVI Ⅱ trial. Eur Heart J, 2024, 45(11): 952-962.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Preliminary effectiveness of the whole-life cycle management model for valvular heart disease at West China Hospital: A retrospective cohort study

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