Remote Monitoring of Patients Undergoing Transcatheter Aortic Valve Replacement: A Framework for Postprocedural Telemonitoring

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

The postprocedural trajectory of patients undergoing transcatheter aortic valve replacement (TAVR) involves in-hospital monitoring of potential cardiac rhythm or conduction disorders and other complications. Recent advances in telemonitoring technologies create opportunities to monitor electrocardiogram (ECG) and vital signs remotely, facilitating redesign of follow-up trajectories.

Objective

This study aimed to outline a potential set-up of telemonitoring after TAVR.

Methods

A multidisciplinary team systematically framed the envisioned telemonitoring scenario according to the intentions, People, Activities, Context, Technology (iPACT) and Functionality, Interaction, Content, Services (FICS) methods and identified corresponding technical requirements.

Results

In this scenario, a wearable sensor system is used to continuously transmit ECG and contextual data to a central monitoring unit, allowing remote follow-up of ECG abnormalities and physical deteriorations. Telemonitoring is suggested as an alternative or supplement to current in-hospital monitoring after TAVR, enabling early hospital dismissal in eligible patients and accessible follow-up prolongation. Together, this approach aims to improve rehabilitation, enhance patient comfort, optimize hospital capacity usage, and reduce overall costs. Required technical components include continuous data acquisition, real-time data transfer, privacy-ensured storage, automatic event detection, and user-friendly interfaces.

Conclusions

The suggested telemonitoring set-up involves a new approach to patient follow-up that could bring durable solutions for the growing scarcities in health care and for improving health care quality. To further explore the potential and feasibility of post-TAVR telemonitoring, we recommend evaluation of the overall impact on patient outcomes and of the safety, social, ethical, legal, organizational, and financial factors.

Related collections

Most cited references 25

Record: found
Abstract: found
Article: not found

Two-year outcomes after transcatheter or surgical aortic-valve replacement.

Susheel Kodali, Mathew R Williams, Craig R Smith … (2012)

The Placement of Aortic Transcatheter Valves (PARTNER) trial showed that among high-risk patients with aortic stenosis, the 1-year survival rates are similar with transcatheter aortic-valve replacement (TAVR) and surgical replacement. However, longer-term follow-up is necessary to determine whether TAVR has prolonged benefits. At 25 centers, we randomly assigned 699 high-risk patients with severe aortic stenosis to undergo either surgical aortic-valve replacement or TAVR. All patients were followed for at least 2 years, with assessment of clinical outcomes and echocardiographic evaluation. The rates of death from any cause were similar in the TAVR and surgery groups (hazard ratio with TAVR, 0.90; 95% confidence interval [CI], 0.71 to 1.15; P=0.41) and at 2 years (Kaplan-Meier analysis) were 33.9% in the TAVR group and 35.0% in the surgery group (P=0.78). The frequency of all strokes during follow-up did not differ significantly between the two groups (hazard ratio, 1.22; 95% CI, 0.67 to 2.23; P=0.52). At 30 days, strokes were more frequent with TAVR than with surgical replacement (4.6% vs. 2.4%, P=0.12); subsequently, there were 8 additional strokes in the TAVR group and 12 in the surgery group. Improvement in valve areas was similar with TAVR and surgical replacement and was maintained for 2 years. Paravalvular regurgitation was more frequent after TAVR (P<0.001), and even mild paravalvular regurgitation was associated with increased late mortality (P<0.001). A 2-year follow-up of patients in the PARTNER trial supports TAVR as an alternative to surgery in high-risk patients. The two treatments were similar with respect to mortality, reduction in symptoms, and improved valve hemodynamics, but paravalvular regurgitation was more frequent after TAVR and was associated with increased late mortality. (Funded by Edwards Lifesciences; ClinicalTrials.gov number, NCT00530894.).

0 comments Cited 372 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Evidence-based surgical care and the evolution of fast-track surgery.

Henrik Kehlet, Douglas Wilmore (2008)

Optimization of postoperative outcome requires the application of evidence-based principles of care carefully integrated into a multimodal rehabilitation program. To assess, synthesize, and discuss implementation of "fast-track" recovery programs. Medline MBASE (January 1966-May 2007) and the Cochrane library (January 1966-May 2007) were searched using the following keywords: fast-track, enhanced recovery, accelerated rehabilitation, and multimodal and perioperative care. In addition, the synthesis on the many specific interventions and organizational and implementation issues were based on data published within the past 5 years from major anesthesiological and surgical journals, using systematic reviews where appropriate instead of multiple references of original work. Based on an increasing amount of multinational, multicenter cohort studies, randomized studies, and meta-analyses, the concept of the "fast-track methodology" has uniformly provided a major enhancement in recovery leading to decreased hospital stay and with an apparent reduction in medical morbidity but unaltered "surgery-specific" morbidity in a variety of procedures. However, despite being based on a combination of evidence-based unimodal principles of care, recent surveys have demonstrated slow adaptation and implementation of the fast-track methodology. Multimodal evidence-based care within the fast-track methodology significantly enhances postoperative recovery and reduces morbidity, and should therefore be more widely adopted. Further improvement is expected by future integration of minimal invasive surgery, pharmacological stress-reduction, and effective multimodal, nonopioid analgesia.

0 comments Cited 348 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

European system for cardiac operative risk evaluation (EuroSCORE).

S Nashef, F. Roques, P. Michel … (1999)

To construct a scoring system for the prediction of early mortality in cardiac surgical patients in Europe on the basis of objective risk factors. The EuroSCORE database was divided into developmental and validation subsets. In the former, risk factors deemed to be objective, credible, obtainable and difficult to falsify were weighted on the basis of regression analysis. An additive score of predicted mortality was constructed. Its calibration and discrimination characteristics were assessed in the validation dataset. Thresholds were defined to distinguish low, moderate and high risk groups. The developmental dataset had 13,302 patients, calibration by Hosmer Lemeshow Chi square was (8) = 8.26 (P 200 micromol/l (2), active endocarditis (3) and critical preoperative state (3). Cardiac factors were unstable angina on intravenous nitrates (2), reduced left ventricular ejection fraction (30-50%: 1, 60 mmHg (2). Operation-related factors were emergency (2), other than isolated coronary surgery (2), thoracic aorta surgery (3) and surgery for postinfarct septal rupture (4). The scoring system was then applied to three risk groups. The low risk group (EuroSCORE 1-2) had 4529 patients with 36 deaths (0.8%), 95% confidence limits for observed mortality (0.56-1.10) and for expected mortality (1.27-1.29). The medium risk group (EuroSCORE 3-5) had 5977 patients with 182 deaths (3%), observed mortality (2.62-3.51), predicted (2.90-2.94). The high risk group (EuroSCORE 6 plus) had 4293 patients with 480 deaths (11.2%) observed mortality (10.25-12.16), predicted (10.93-11.54). Overall, there were 698 deaths in 14,799 patients (4.7%), observed mortality (4.37-5.06), predicted (4.72-4.95). EuroSCORE is a simple, objective and up-to-date system for assessing heart surgery, soundly based on one of the largest, most complete and accurate databases in European cardiac surgical history. We recommend its widespread use.

0 comments Cited 269 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Marije M Vis:

ORCID: http://orcid.org/0000-0002-1284-4492

Heart CentreAcademic Medical CentreUniversity of AmsterdamPO Box 22660Amsterdam, 1100 DDNetherlands31 5666555m.m.vis@amc.uva.nl

Journal

Journal ID (nlm-ta): JMIR Cardio

Journal ID (iso-abbrev): JMIR Cardio

Journal ID (publisher-id): JCARD

Title: JMIR Cardio

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 2561-1011

Publication date Collection: Jan-Jun 2018

Publication date (Electronic): 16 March 2018

Volume: 2

Issue: 1

Electronic Location Identifier: e9

Affiliations

[1] ¹ Heart Centre Academic Medical Centre University of Amsterdam Amsterdam Netherlands

[2] ² Department of Technical Medicine University of Twente Enschede Netherlands

[3] ³ Biomedical Signals and Systems Group University of Twente Enschede Netherlands

Author notes

Corresponding Author: Marije M Vis m.m.vis@ 123456amc.uva.nl

Author information

Mathilde C Hermans http://orcid.org/0000-0002-1144-3793

Martijn S Van Mourik http://orcid.org/0000-0001-8994-8946

Hermie J Hermens http://orcid.org/0000-0002-3065-3876

Jan Baan Jr http://orcid.org/0000-0002-5511-633X

Marije M Vis http://orcid.org/0000-0002-1284-4492

Article

Publisher ID: v2i1e9

DOI: 10.2196/cardio.9075

PMC ID: 6834331

SO-VID: 696001af-3a6b-493e-aaec-1baa0dd472f5

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Cardio, is properly cited. The complete bibliographic information, a link to the original publication on http://cardio.jmir.org, as well as this copyright and license information must be included.

History

Date received : 28 September 2017

Date revision requested : 17 December 2017

Date revision received : 2 February 2018

Date accepted : 17 February 2018

Comments

Comment on this article

scite_

Cited by 4

See all cited by

Most referenced authors 774

See all reference authors

Submit your digital health research with an established publisher
- celebrating 25 years of open access