In April 2025, NHS England’s Getting It Right First Time (GIRFT) programme introduced a nationally standardised eight-week treatment pathway for patients with severe aortic stenosis (AS). This system-level reform targets persistent delays between diagnosis and intervention for Aortic Stenosis. By replacing fragmented local processes with a unified operational standard, the GIRFT pathway marks a transition from aspirational guidance to enforced, time-bound delivery. This is supported by patient advocacy and awareness efforts led by organisations such as Heart Valve Voice.
Diagnosis to recovery pathway overview
Patients referred for potential aortic stenosis follow a streamlined pathway coordinated through a Single Point of Access, ensuring rapid triage and equitable access across ICSs. After diagnostic confirmation, cases are reviewed by a multidisciplinary team to determine suitability for TAVI or SAVR. Once a treatment plan is agreed, patients are optimised pre-procedure and admitted to ring-fenced beds on the day of intervention. The full diagnosis-to-treatment timeline is capped at eight weeks, with fast-tracked cases treated within six. Discharge is usually within 72 hours, with follow-up including a six-week clinical review and cardiac rehab starting at eight weeks.
What are the key challenges?
The successful roll-out of the GIRFT pathway will depend on the NHS’s ability to scale supporting infrastructure (particularly imaging capacity, MDT coordination and digital triage systems). While tertiary centres are well positioned, variations in workforce and diagnostics across ICSs remain a constraint. Addressing cath lab bottlenecks and investing in referral system interoperability will be essential.
Crucially, the GIRFT model aligns with the NHS elective recovery agenda. This offers an opportunity to link pathway compliance to commissioning and performance-based funding, provided that governance safeguards ensure clinical judgement is not overridden by throughput pressures.
Improving the clinical trajectory for AS patients
The pathway intervenes at the most critical point in the AS trajectory, between symptomatic onset and definitive care, offering a major opportunity to reduce mortality and hospital admissions. For elderly or frail patients, accelerated access may prevent irreversible cardiac deterioration and reduce emergency presentations.
System-wide, GIRFT supports better resource use by smoothing procedural demand, reducing length of stay and improving the predictability of care delivery. The model also provides a scalable framework for other time-sensitive cardiovascular conditions where delays drive outcome disparities.
A replicable blueprint for cardiovascular reform
The GIRFT 8-week aortic stenosis pathway represents a clinically grounded, operationally robust framework for structural heart disease reform. It demonstrates how data-driven policy, multidisciplinary alignment and time-bound standards can deliver measurable improvement. For patients, it provides access and certainty. For clinicians, clear protocols and team-based decision-making. For the NHS, a replicable solution to longstanding inefficiencies in cardiovascular care.