INVOLVE: Individualised Follow-up After Valve Surgery

Sponsor
Odense University Hospital (Other)
Overall Status
Completed
CT.gov ID
NCT03053778
Collaborator
(none)
1,414
1
1
19
74.5

Study Details

Study Description

Brief Summary

This study aims to investigate the effect of an intervention consisting of early, individualised outpatient follow-up after heart valve surgery on unplanned readmissions and death within 180-days after discharge.

Furthermore, Health economics and health-related quality of life will be investigated.

Condition or Disease Intervention/Treatment Phase
  • Other: Early follow-up
N/A

Detailed Description

The incidence of valvular heart disease is estimated to exceed 42 million people worldwide. In Denmark 1700 patients undergo heart valve surgery every year and the number is increasing due to an ageing population. The most common heart valve diseases is aortic stenosis, followed by mitral regurgitation and aortic regurgitation, whereas only few patients are treated in Denmark for mitral stenosis and primary tricuspid valve and pulmonic valve diseases.

Heart valve surgery can be a lifesaving procedure for patients with severe symptomatic heart valve disease, but complications after heart valve surgery are common and readmissions frequent with rates exceeding 40% in Denmark. Most frequent causes for readmission, includes new onset atrial fibrillation, pleural and pericardial effusions, infections and acute heart failure. These causes can potentially be detected by careful outpatient follow-up in order to avoid unplanned readmission, and improve mental, physical and social health outcomes. A recent Danish study demonstrated that 56% of surgical heart valve patients were readmitted within a year and readmission was associated with low psychical and mental PROs. PROs' include validated patient health status surveys that allow quantification of critical patient-centered outcomes. Further previous studies have suggested an association between PROs and prolonged hospital stay, morbidity and mortality in cardiac patients. Knowledge about PROs can potentially be used to identify patients that especially may benefit from intensified follow-up after heart valve surgery.

Existing guidelines recommend that patients following valve surgery are reviewed on a regular basis by a cardiologist with special knowledge about heart valve diseases. A recent European study demonstrate though, a gap between the existing guidelines and clinical practice. A plausible way to improving the postoperative care could be to introduce a multidisciplinary heart valve clinic (HVC), where specialized nurses educates the patients while intervening and supporting the patients after surgery in collaboration with cardiologist and surgeons. This has proven efficient in improving outcomes such as, mortality, readmission and quality of life in patients with heart failure.3 A multidisciplinary teamwork can provide a timely access to a clinical review of the patient and simultaneously look for signs and symptoms of valve dysfunction.18 Although, previous studies have described the HVCs. Although, previous studies have described the HVCs, the effect gained from HVC compared to usual care on readmission, mortality, cost-utility and patient-reported outcomes have not yet systematically been investigated.

The aim for this study is firstly to describe PROs after heart valve surgery, incorporate the knowledge into a structured intervention, and secondly to evaluate a HVC and its association to PRO's, readmission, mortality and cost-utility.

The study consist of two parts,

  • Matched cohort study comparing HVC to a historical control group to evaluate the effect of the HVC on readmission, mortality and HRQoL.

  • A health economic analysis of effect of the HVC compared to a historical control Group.

The intervention and collection of clinical data: Introducing a HVC to gain knowledge of its effect on readmission, mortality and health economics.

Preoperative: Clinical data regarding the patient will be gathered at admission including calculated Euroscore II, pulmonary function measured with spirometry, status on nutrition, smoking and alcohol consumption, BMI, electrocardiography (ECG), and most recent echocardiography. Furthermore, the patients' frailty status will be assessed with a gait speed test the day before surgery and will be used in the risk model.

Postoperative: Before discharge a trained cardiac nurse will perform a screening for pleural and pericardial effusion, volume overload, risk for atrial fibrillation and repeat frailty assessment. Before discharge the patients' medication will be evaluated and adapted according to their clinical status, and the patients will be educated in warning signs after surgery. The surgical status will be evaluated before discharge. Based on these data and the PROs the patients' follow-up will be individualized.

Follow-up: The specific follow-up will be planed according to the patients' status where patients considered at high risk of being readmitted based on the clinical evaluation at discharge (e.g. atrial fibrillation) will have a more intensive follow-up. The focus of the follow-up will be a status on the patients' physical condition regarding; weight, pain and shortness of breath in combination with the areas of the PROs from study I. Consideration on further follow-up will be made depending on the condition of the patient.

After 1 month all patients will be seen in the HVC where ECG and echocardiography will be performed. At each visit the patient will be educated and informed regarding the disease and illnesses, which should lead to a better understanding and self-management of care in the post-operative period. The aim of the education is to give the patient the insight to promptly identify and report the symptoms and signs for progression of their valve disease or dysfunction of their prosthetic or repaired valve. The patient education thereby also aims to improve the patients' wellbeing and psychological condition by an increase of the feeling of security and by preventing poor physical outcomes.

Study Design

Study Type:
Interventional
Actual Enrollment :
1414 participants
Allocation:
N/A
Intervention Model:
Single Group Assignment
Masking:
None (Open Label)
Primary Purpose:
Prevention
Official Title:
Individualised Follow-up After Valve Surgery
Actual Study Start Date :
Nov 1, 2016
Actual Primary Completion Date :
Jun 2, 2018
Actual Study Completion Date :
Jun 2, 2018

Arms and Interventions

Arm Intervention/Treatment
Experimental: Intervention

Early follow-up after discharge

Other: Early follow-up
Early follow-up until 4 weeks after discharge

Outcome Measures

Primary Outcome Measures

  1. Reduction of readmission [Up to two years]

    Reduction of readmission. a controlled prospective intervention trial comparing readmission rates and all-cause mortality in patients undergoing individualized follow-up with a historical control Group. A propensity matching will be performed

Secondary Outcome Measures

  1. Differences in costs between the two groups [Up to three years]

    Health economics as measured by differences in the two groups. Further more a cost-utility analysis of cost and quality of life. The cost utility analysis is measured with a questionnaire

  2. Quality of Life and associations with readmission [Up to three years]

    Symptoms of health related quality of life measured with a questionnaire

  3. The effect of a Heart valve Clinic on patient-reported outcomes [Up to three years]

    Symptoms of disease specific quality of life measured with a questionnaire

  4. Frailty status after Heart valve surgery [Up to two years]

    Measuring of frailty status at discharge and associations to other outcomes

Eligibility Criteria

Criteria

Ages Eligible for Study:
N/A and Older
Sexes Eligible for Study:
All
Accepts Healthy Volunteers:
No
Inclusion Criteria:
  • Patient having Heart Valve Surgery at Odense University Hospital, Denmark
Exclusion Criteria:
  • None

Contacts and Locations

Locations

Site City State Country Postal Code
1 Odense University Hospital Odense Denmark 5000

Sponsors and Collaborators

  • Odense University Hospital

Investigators

  • Principal Investigator: Britt Borregaard, Odense University Hospital

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.
Responsible Party:
Britt Borregaard, Principal Investigator, Odense University Hospital
ClinicalTrials.gov Identifier:
NCT03053778
Other Study ID Numbers:
  • 222
First Posted:
Feb 15, 2017
Last Update Posted:
Aug 1, 2018
Last Verified:
Jul 1, 2018
Individual Participant Data (IPD) Sharing Statement:
Undecided
Plan to Share IPD:
Undecided
Studies a U.S. FDA-regulated Drug Product:
No
Studies a U.S. FDA-regulated Device Product:
No
Keywords provided by Britt Borregaard, Principal Investigator, Odense University Hospital
Additional relevant MeSH terms:

Study Results

No Results Posted as of Aug 1, 2018