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Clinical Trial Details — Status: Terminated

Administrative data

NCT number NCT02766075
Other study ID # 837484
Secondary ID
Status Terminated
Phase N/A
First received April 28, 2016
Last updated April 10, 2018
Start date May 2016
Est. completion date February 2018

Study information

Verified date April 2017
Source OSF Healthcare System
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The aim of this pilot study is to establish whether a Supervised TAVR Exercise Program (STEP) can safely improve the frailty status in patients with symptomatic severe aortic valve stenosis prior to undergoing transcatheter aortic valve replacement (TAVR).


Description:

TAVR is an approved alternative therapy for patients with severe aortic valve stenosis who are deemed inoperable or high-risk for surgical aortic valve replacement (SAVR). Despite a very high procedural success rate (>95%), mortality rates after TAVR at 1- and 2-year follow-up remain ≥25% and ≥34%, respectively. It is becoming increasingly evident that frailty, as a clinical syndrome, has a large impact on this long term mortality. In a study by Green, et al. frailty status was independently associated with increased 1-year mortality (OR=3.5) after TAVR. The investigators' own retrospective analysis showed that impaired mobility and malnutrition were significantly associated with a longer hospital length of stay (5 days vs. 3 days), and increased total cost (on average, an additional $10,000 per patient). Given the phenotype of frailty is characterized by reductions in muscle mass, strength, endurance and activity level, a STEP is ideally suited to counteract these impairments. This pilot study aims to establish whether a STEP can safely improve the frailty score in patients with symptomatic severe aortic valve stenosis prior to undergoing TAVR.

This single-center pilot study will be conducted in partnership between Heart Care Midwest (HCMW), OSF St. Francis Medical Center (OSF SFMC), and University of Illinois College of Medicine at Peoria (UICOMP). UICOMP Center of Outcomes Research will provide analytical support. The study will be funded by an operational research grant from OSF SFMC.


Recruitment information / eligibility

Status Terminated
Enrollment 4
Est. completion date February 2018
Est. primary completion date February 2018
Accepts healthy volunteers No
Gender All
Age group 50 Years and older
Eligibility Inclusion Criteria:

- All adult patients scheduled to undergo first-time elective TAVR

Exclusion Criteria:

- Vulnerable populations including prisoners, pregnant females and patients less than 18 years age.

- Patients with history of unstable angina, myocardial infarction, or decompensated heart failure in the week prior to screening

- Patients with physical limitations (i.e. debilitating stroke, amputation, unable to complete initial screening frailty profile)

- Patients with advanced dementia or cognitive deficits (i.e. unable to follow instructions of initial screening frailty profile)

- Exercise-induced arrhythmias

Study Design


Related Conditions & MeSH terms


Intervention

Behavioral:
Supervised TAVR Exercise Program
Individualized exercise program designed and implemented by licensed physical therapy clinicians in three 60-minute sessions per week for four weeks. Upon randomization, subjects in the Intervention Group will undergo an initial Dynamic Gait & Balance Assessment by a licensed physical therapy clinician. The physical therapy clinician will use this assessment to design and implement an individualized STEP in three 60-minute sessions per week for four weeks. Subjects will proceed with their pre-TAVR testing in conjunction with the STEP sessions.

Locations

Country Name City State
United States OSF St. Francis Medical Center Peoria Illinois

Sponsors (4)

Lead Sponsor Collaborator
OSF Healthcare System HeartCare Midwest, OSF St. Francis Medical Center, University of Illinois College of Medicine at Peoria

Country where clinical trial is conducted

United States, 

Outcome

Type Measure Description Time frame Safety issue
Primary Change in Frailty Score from Baseline to post-STEP Baseline, 6-weeks
Secondary Adverse Events 6-weeks
Secondary Change in Frailty Score from Baseline to 30-days post-TAVR Baseline, 30-days post-TAVR
Secondary Change in Gait Speed (5-Meter Walk Test) from Baseline to post-STEP Baseline, 6-weeks
Secondary Change in Gait Speed (5-Meter Walk Test) from Baseline to 30-days post-TAVR Baseline, 30-days post-TAVR
Secondary Change in Grip Strength (Dynamometer) from Baseline to post-STEP Baseline, 6-weeks
Secondary Change in Grip Strength (Dynamometer) from Baseline to 30-days post-TAVR Baseline, 30-days post-TAVR
Secondary Change in Independent Activity (Katz Activities of Daily Living Survey) from Baseline to post-STEP Baseline, 6-weeks
Secondary Change in Independent Activity (Katz Activities of Daily Living Survey) from Baseline to to 30-days post-TAVR Baseline, 30-days post-TAVR
Secondary Change in Malnutrition (Serum Albumin Level) from Baseline to 30-days post-TAVR Baseline, 30-days post-TAVR
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