scholarly journals Promoting Early Mobility in Patients After Transcatheter Aortic Valve Replacement: An Evidence-Based Protocol

2021 ◽  
Vol 41 (5) ◽  
pp. e9-e16
Author(s):  
Lindsey Hart ◽  
Robert Frankel ◽  
Gregory Crooke ◽  
Stefanie Noto ◽  
Mary Alice Moors ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Aortic Valve ◽  
Length Of Stay ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Evidence Based ◽  
Early Mobility ◽  
Transcatheter Aortic Valve

Background Aortic stenosis is prevalent among older adults and is commonly treated with transcatheter aortic valve replacement. Both high- and low-risk patients benefit from early mobility and discharge after this procedure; however, hospital protocols to improve patient mobility and shorten hospital stays have not been systematically implemented. Objective To develop and evaluate a post–transcatheter aortic valve replacement protocol to standardize care and efficiently advance patients from the operating room to discharge. Methods A prospective pre-post design was used to evaluate the effect of the new standardized protocol on length of stay, timing of mobility, time spent in intensive care, and quality of life in patients undergoing transcatheter aortic valve replacement between April 2019 and March 2020. Interventions Interventions included team-based education and integration of an evidence-based order set into the electronic health record. Education was provided to both patients and staff. Results At 6 months after implementation of the intervention, statistically significant improvements were observed in mean overall (5.26 vs 2.45 days; P = .001) and postprocedure (3.05 vs 2.16 days; P = .004) length of stay. No significant difference was found in performance on the 5-meter walk test. Quality of life improved in both groups from baseline to 30-day follow-up (P = .01). Conclusion Implementation of the post–transcatheter aortic valve replacement protocol was associated with significant improvement in overall and postprocedure length of stay and improved quality of life. Additional work is needed to examine strategies to ensure safe next-day discharge.

Abstract 17135: Promoting Early Mobility and Discharge in Patients Post-Transcatheter Aortic Valve Replacement

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Lindsey Hart ◽  
Robert Frankel ◽  
Gregory Crooke ◽  
Mary Alice Moors ◽  
Stefanie Noto ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Aortic Valve ◽  
Length Of Stay ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Early Mobility ◽  
Transcatheter Aortic Valve ◽  
Post Procedure

Background: Aortic stenosis is a common disease that affects older adults. With an expanded indication, low-risk patients can now be offered the option of TAVR. Hospitals will need to effectively and efficiently accommodate the expected increase in demand for the TAVR procedure without compromising patient outcomes. Objective: The purpose of this study was to evaluate the development of a post-transcatheter aortic valve replacement protocol to standardize care and progress the patient from the operating room to discharge. Methods: We used a prospective pre-post design to evaluate the effect of education and a technology-supported intervention on length of stay, quality of life (measured by the Kansas City Cardiomyopathy Questionnaire; KCCQ12), and early mobility in TAVR patients between April 2019 and March 2020. Interventions: Two components of the intervention included team-based education and integration of guideline-based orders in the electronic record (EHR). Education regarding expectations for early mobilization and discharge plan was provided to patient and staff to ensure a timely discharge home. Results: Overall and post-procedural length of stay were significantly improved (5.26 days vs 2.45; p<0.001 and 3.05 days vs 2.16 days; p<0.004) respectively. Quality of life improved in both groups from baseline to 30 day follow up (p=0.012) No significant difference was shown in the 5-meter walk test. Conclusion: These findings suggest that implementation of an evidence based EHR-embedded order set is associated with a significant improvement in overall and post-procedure length of stay at 6 moths and a significant improvement in post-procedure quality of life. Future work is needed to examine strategies to ensure safe next day discharge.

Very Early Changes in Quality of Life After Transcatheter Aortic Valve Replacement: Results From the 3M TAVR Trial

2020 ◽  
Vol 21 (12) ◽  
pp. 1573-1578
Author(s):  
Sandra B. Lauck ◽  
Suzanne V. Arnold ◽  
Britt Borregaard ◽  
Janarthanan Sathananthan ◽  
Karin H. Humphries ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Transcatheter Aortic Valve

4071Early changes in quality of life after transcatheter aortic valve replacement: One-year results from the 3M TAVR Study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Lauck ◽  
D A Wood ◽  
S J Baron ◽  
B Borregaard ◽  
H Wijeysundera ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Kansas City ◽  
Clinical Pathways ◽  
Summary Score ◽  
Transcatheter Aortic Valve

Abstract Background In patients with severe calcific aortic stenosis, transcatheter aortic valve replacement (TAVR) has been shown to significantly improve quality of life (QOL). However, changes in QOL at early follow-up (<1 month), and following next-day discharge are poorly understood. Methods A total of 411 patients at 13 centers were enrolled in the Multimodality, Multidisciplinary but Minimalist TAVR (3M TAVR) study in 2015–2017. QOL was evaluated using the Kansas City Cardiomyopathy Questionnaire (KCCQ-12) in participants with a baseline score and at least one score at 2 weeks, 30 days and 1 year. Study endpoints were change in (1) KCCQ-Overall Summary Score (KCCQ-OS) and (2) minimal clinically important differences (MCID). Mixed effects models were used to explore patterns of change from baseline, with fixed terms for time, status at 1-year and their interaction terms, and a random intercept for subject to account for within subject correlation. Descriptive statistics were used to report MCID. Results Data were available for 358 (87.1%) participants. 216 (60.3%) were men with a median age 84.0 and STS 5.0 There was significant increase in QOL 2 weeks after TAVR (p≤0.01), and further significant improvement at the 1-month timepoint (p<0.01) for participants who were alive at 1 year. Sex, age category, and STS score category did not have a significant effect on the change in QOL (p>0.05). In the first 2 weeks, moderate (10–20 points) and large (>20 points) improvements were observed in 19.9% and 49.0% of the surviving patients, respectively; at 1-year, similar MCID were seen in 14.6% and 64.0% respectively. Figure 1 Conclusion This is the first study to report significant increase in QOL 2 weeks after TAVR, with sustained improvement during the first year in patients treated with the Vancouver TAVR Clinical Pathway with a goal of next-day discharge. Further studies are necessary to determine whether alternative TAVR clinical pathways yield similar findings. Acknowledgement/Funding Investigator-initiated unrestricted research grant, Edwards

Sign in / Sign up

Export Citation Format

Share Document