Sandra B. Lauck

Growing evidence demonstrates the impact of health disparities on stroke care and outcomes. Although reviews have examined disparities related to sex and gender, race and ethnicity, socioeconomic status and rural–urban residence, most have not accounted for the influence of multiple intersecting social identities or positions. This critical integrative review used a modified integrative review methodology with an intersectionality approach. We reported bibliographic trends and generated Upset Plots to analyze intersections among categories of social identity/position. Analysis was iterative to identify patterns and relationships between and within categories. We included 471 records and 392 conference proceedings published over 34 years (1991–2024). Most studies (60.1%) were from the United States and included only individuals with ischemic stroke (48.8%). A total of 59.9% reported on race and/or ethnicity disparities, followed by 43.7% on sex and (cis)gender. Studies focused on geography, migrants, transients and refugees, individuals experiencing homelessness, sexual and gender minorities, and individuals with substance use disorder were lacking. The largest set of studies reporting on at least 2 categories was the combination of race and/or ethnicity, sex and cis(gender) and age. Only 68 (14.9%) quantitative studies conducted intersectional analyses, with the largest intersection being race and/or ethnicity with sex and (cis)gender. Studies often used a unidimensional approach to social identities or positions and focused on identifying and quantifying disparities, with minimal consideration of their intersecting nature and explanatory drivers. Studies on how disparities are experienced by individuals living with stroke were rare. To advance health equity in stroke care and research, studies using an intersectionality framework are needed.

Transcatheter aortic valve implantation (TAVI) has evolved into the dominant therapeutic option for severe aortic stenosis, with procedural refinements and expanding indications increasingly supporting shorter post-procedural monitoring and discharge. International evidence from randomized trials, multi-center registries, and consensus guidelines demonstrates that reduced length of stay (LOS), including next-day or early discharge, can be safely achieved in selected patients when supported by standardized workflows, careful patient selection, and structured outpatient monitoring. In Germany, LOS remains among the longest in Europe, driven by structural, reimbursement, and cultural barriers. With increasing TAVI volumes, demographic pressures, and workforce constraints, these barriers inhibit health system sustainability, procedural capacity, and patient experience. Early discharge below the currently defined thresholds often results in financial disadvantages under the Diagnosis-Related Group (DRG) reimbursement mechanism, thereby disincentivizing standardized adoption and pathway innovation. Yet, a reduction in LOS would yield meaningful system-level advantages, including increased procedural capacity, improved resource allocation, and lower post-procedural bed occupancy costs, all leading to better and more efficient patient pathways. This narrative, practice- and policy-oriented critical perspective evaluates the current German landscape and outlines pragmatic strategies to enable safe early discharge. It synthesizes relevant international evidence, identifies system-level barriers specific to Germany, and proposes a structured roadmap including: (1) standardized eligibility criteria, (2) protocolized peri- and post-procedural pathways, (3) pilot implementation in carefully selected centers with outcome reporting, and (4) reimbursement realignment to avoid wrong financial incentives. Supported by professional medical societies and aligned with international standards, early discharge pathways could enhance efficiency and improve patient-centered care, offering Germany a timely opportunity to modernize TAVI experience and delivery. Graphical Abstract The alternative text for this image may have been generated using AI.

People with cardiovascular conditions do not always receive care that aligns with the best available evidence or clinical guidelines. Moving evidence into practice is complex. Implementation science can inform and enable efforts to successfully achieve this. In this EJCN Methods Corner paper, we offer 10 evidence-informed considerations on designing and conducting an implementation study that evaluates the implementation process and effectiveness of implementation strategies. Tools and resources to support these considerations are provided. Implementation studies guided by conceptual thinking, strengthened by knowledge user engagement, and centred in equity generates the empirical knowledge needed to identify best practices in how to effectively and efficiently implement change.

Aims: To report on the unique perspectives of senior nursing leaders on the value proposition of the Clinical Nurse Specialist (CNS) role, their organisational experience and the barriers and facilitators to optimise and promote the long‐term sustainability. Design: A qualitative sub‐study of a larger multi‐method study focused on informing policy recommendations to optimise the CNS workforce, informed by integrated knowledge translation. Methods: Chief Nursing Officers (CNOs) and other senior leaders in all health authorities in British Columbia, Canada, were invited to participate in semi‐structured interviews via video call between August–December 2023. We recruited 13 participants from diverse health regions, including 5 CNOs. Results: Leaders collectively conveyed a renewed interest in the CNS role to support nursing and multidisciplinary teams to better meet patient and system needs, and a sense of urgency to optimise the role in diverse settings. The overarching theme of “success by design” was supported by three thematic priorities: (1) understanding the CNS role, (2) a role that needs protection and connections and (3) moving forward together. Views were aligned to co‐construct implementation‐ready policy recommendations to guide provincial strategies. Conclusion: Senior leaders reported a common understanding of the value‐add of the CNS workforce and had a shared experience of barriers to optimisation. Contemporary policy guidance is needed to equip health systems to address this gap. Impact: Across international regions, the role of CNSs is not fully optimised. This is a wasted opportunity to address the pressing need for nursing practice leaders to transform health systems and improve outcomes. This study provides new knowledge about the perspectives of Chief Nursing Officers and other nursing leaders to shape comprehensive and targeted policy recommendations and address enduring and new challenges to realise the full impact of the CNS workforce. Reporting Methods: We have adhered to COREQ reporting guidelines (See supplemental file). Patient and Public Involvement: This study did not include patient or public involvement in its design, conduct, or reporting.

Background: Transcatheter options are increasingly available for the treatment of valvular heart disease. The role of the clinical valve co-ordinator is ideally positioned to improve access to care, quality of outcomes, and patient experiences, contribute to efficiencies, and support the growing number of heart valve centres. International societies and guidelines recommend the inclusion of the clinical valve co-ordinator in multidisciplinary Heart Teams to support patients, contribute unique expertise to team-based care, and help programmes expand access to care. The role of the clinical valve co-ordinator is unevenly adopted in Europe. Aims: To provide guidance on developing, implementing, and sustaining the role of clinical valve co-ordinators to support patients and programmes. Methods and results: We outline a comprehensive framework of the competencies and professional development aligned with the needs of patients with aortic, mitral, and tricuspid disease, discuss requirements for infrastructure and successful organizational integration in valvular heart disease teams and programmes, and propose preliminary indicators to measure role impact and address the current gap in evidence to guide role development across diverse regions. The clinical valve co-ordinator plays a vital role as a central member of the multidisciplinary team to support the care requirements of people with complex valvular heart disease in the rapidly evolving clinical context of treatment options and management strategies. Conclusion: The document provides a roadmap for the development, implementation, and evaluation of a pan-European initiative to improve the delivery of valvular heart disease services and optimize the experience of care of patients and their family.

Background: Shared decision-making (SDM) is widely endorsed in international guidelines for the treatment of valvular heart disease (VHD). Despite evidence that the process improves outcomes and does not increase the burden of consultations, SDM has not been adopted as a standard of care across regions and diverse health systems. Methods: We conducted a 3-phase study co-led by clinicians and people with lived experience using an integrated knowledge translation approach guided by the knowledge-to-action framework. In a preparatory phase, we conducted exploratory semi-structured interviews with 19 international and diverse experts to identify barriers and enablers to SDM in VHD; we used thematic analysis to identify the major issues to inform project development. We convened an in-person meeting of patients and patient advocates ( n = 9), clinicians ( n = 11) and researchers ( n = 3) from 10 countries to build joint recommendations. Lastly, we conducted a series of local and international meetings to validate the findings and inform future initiatives. Results: Challenges identified included (1) concerns about clinicians’ availability and time requirements, (2) uncertainty about how to practice SDM and (3) absence of regional data to evaluate SDM in VHD. The joint recommendations clustered on five global areas of focus and six sets of recommendations tailored to regional contexts and cultural norms. Final recommendations on (1) preparing patients and carers, (2) training healthcare teams and (3) creating a supportive system were further enhanced by VHD knowledge users’ input in various regional settings. Conclusions: This first report co-led by diverse stakeholders offers a practice and policy-ready roadmap to strengthen the implementation and evaluation of SDM in VHD.