Physical Therapy and Occupational Therapy After Transcatheter Aortic Valve Replacement

Transcatheter Aortic Valve Implantation Clinical Trial

— PTOTtAVR  

Official title:

Physical Therapy and Occupational Therapy After Transcatheter Aortic Valve Replacement

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03117296
• Other study ID #: 10437
• Status: Completed
• Start date: December 3, 2014
• Est. completion date: December 31, 2017

Study information

• Verified date: April 2022
• Source: Henry Ford Health System
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational [Patient Registry]

Clinical Trial Summary

Implementation of Physical Therapy (PT) and Occupational Therapy (OT) pathway (initiation of services on Post procedure day #1 and continued daily with focus on education and activity progression) for all patients undergoing a transcatheter aortic value repair procedure began on December 2, 2014. Retrospective data was collected from The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Aortic Valve Replacement Procedures (STS/ACC TVT, trademark) Registry - National database for Transcatherter Aortic Valve Replacement Procedures and included subjects from March 2012 through July 31, 2015. Patients included: s/p tAVR via transfemoral catheter approach, with or without minor intra or post procedure events (GI bleeds, minor access bleeds, afib, etc); Exclusions: Major events including stroke, pacemaker placement, other cardiovascular (CV) repair or surgery required, etc). Future data analysis will extend subjects to December 31, 2015 and annually.

Description:

Rationale: Frequency of transcatheter and other structural heart procedures increased dramatically from 2012 to 2014 and is trending even higher for 2015. Procedures increased from 15 in 2012 to 50 cases in 2013 (233% increase) and to 70 cases in 2014 (40% increase from 2013 to 2014.) -- PT and OT identified a gap in consults and need for specific education targeted for a new surgery population (tAVR) without sternotomy. Often consults were placed on day of discharge to rehab facility or not at all. -- Structural Heart division of CV institute identified increased length of stay (LOS) and decreased activity of their patients in the hospital. -- No literature on this subject found via Henry Ford Hospital Sladen Library PubMed literature review

Aim: • Create a standardized pathway for new transcatheter aortic valve replacement patients in the Structural Heart Division (SHD)

• Improve patient outcomes including increasing the percentage of patients returning to home rather than a rehab facility destination at discharge

• Decrease length of stay

Implementation:

• Plan: PT and OT identified a gap in consults and need for specific education targeted at a new surgeries population (tAVR); Structural Heart division of CV institute identified an increase LOS and decreased activity of their patients in the hospital. In October 2014 planning began to introduce a SHD tAVR pathway that would include post procedure day number 0 nursing requirements and training, post procedure day number 1-3 PT and OT assessment and interventions.

• Do: Implemented pathway in November 2014.

• Check: Order set revision; Patient handouts ; Cardiac Rehab; Weekend criteria; staff training

• Act: February 2015, order sets in place, patient handouts finalized and full pathway finalized for post op tAVR patients.

• Continued checks identified additional SHD procedures and team determined that Mitral Clips and LARIATs were not criteria for tAVR pathway but would receive routine PT and OT consults.

Intervention: • Added PT and OT to Structural Heart Order Set.

• PT and OT assessments completed on post procedure day number day 1.

• PT and OT follow up treatments post procedure day number 2, 3 and beyond as appropriate.

• Patient education handouts individualized for patient population

• Pre-op education handouts individualized for patient population

Outcome measures: Hospital Length of stay, discharge disposition. Data Analysis: Chi-square tests are used to compare proportions between groups, while Wilcoxon two-sample tests are used to compare distributions of continuous variables between groups. This nonparametric test was chosen due to non-Gaussian distribution of the continuous outcomes within groups. Statistical significance was set at p<0.05. All analyses were performed using SAS 9.4 (SAS Institute Inc, Cary, North Carolina, USA).

Recruitment information / eligibility

• Status: Completed
• Enrollment: 189
• Est. completion date: December 31, 2017
• Est. primary completion date: July 31, 2015
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A and older

Eligibility

Inclusion Criteria:

• admission to henry ford hospital after March 1, 2012

• status post transcatheter aortic valve replacement via transfemoral catheter approach, with or without minor intra or post procedure events (GI bleeds, minor access bleeds, afib, etc)

Exclusion Criteria:

• Occurrence of major events including stroke, pacemaker placement, other CV repair or surgery required, etc)

• procedure via appropriate other than femoral access (transapical, transcaval)

Related Conditions & MeSH terms

• Transcatheter Aortic Valve Implantation

Intervention

Other:
• Post procedure daily PT and OT
PT evaluation and treatment on post procedure day zero: Nurses mobility patient using egress testing one time
• PT post procedure
post procedure day one: PT and OT assessment, education and intervention.
• OT post procedure
PT and OT Daily until goals met or patient discharge.
• Routine PT or OT
Routine PT or OT consulted by physician when identified discharge disposition of home

Locations

Country	Name	City	State
United States	Henry Ford Hospital	Detroit	Michigan

Sponsors (2)

Lead Sponsor	Collaborator
Henry Ford Health System	Henry Ford Hospital

Country where clinical trial is conducted

United States, 

References & Publications (3)

Babaliaros V, Devireddy C, Lerakis S, Leonardi R, Iturra SA, Mavromatis K, Leshnower BG, Guyton RA, Kanitkar M, Keegan P, Simone A, Stewart JP, Ghasemzadeh N, Block P, Thourani VH. Comparison of transfemoral transcatheter aortic valve replacement performed in the catheterization laboratory (minimalist approach) versus hybrid operating room (standard approach): outcomes and cost analysis. JACC Cardiovasc Interv. 2014 Aug;7(8):898-904. doi: 10.1016/j.jcin.2014.04.005. Epub 2014 Jul 30. — View Citation

Marcantuono R, Gutsche J, Burke-Julien M, Anwaruddin S, Augoustides JG, Jones D, Mangino-Blanchard L, Hoke N, Houseman S, Li R, Patel P, Stetson R, Walsh E, Szeto WY, Herrmann HC. Rationale, development, implementation, and initial results of a fast track protocol for transfemoral transcatheter aortic valve replacement (TAVR). Catheter Cardiovasc Interv. 2015 Mar;85(4):648-54. doi: 10.1002/ccd.25749. Epub 2014 Nov 29. — View Citation

Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Sondergaard L, Mumtaz M, Adams DH, Deeb GM, Maini B, Gada H, Chetcuti S, Gleason T, Heiser J, Lange R, Merhi W, Oh JK, Olsen PS, Piazza N, Williams M, Windecker S, Yakubov SJ, Grube E, Makkar R, Lee JS, Conte J, Vang E, Nguyen H, Chang Y, Mugglin AS, Serruys PW, Kappetein AP; SURTAVI Investigators. Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2017 Apr 6;376(14):1321-1331. doi: 10.1056/NEJMoa1700456. Epub 2017 Mar 17. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Post Procedure Hospital Length of Stay	From date of procedure until date of hospital discharge, assessed up to 50 days.	at discharge
Primary	Total Hospital Length of Stay	Days from Hospital admission to Hospital Discharge	at discharge
Secondary	Discharge Disposition, Home	Discharge destination at discharge. Home includes those discharge home, Home with assistance or Home with Home care.	on day of hospital discharge
Secondary	Discharge Destination, Rehab Facility	At hospital discharge, did the patient return Home or were they discharged to a post-acute care Rehab Facility	on day of hospital discharge