The primary objective of the evaluation study is to determine if geriatric co-management is superior to standard of care in preventing functional decline in older patients admitted for acute heart disease or Transcatheter Aortic Valve Implementation (TAVI) to the cardiology units of the University Hospitals Leuven.
This study aims to implement and evaluate a geriatric co-management intervention in older patients admitted for acute heart disease or Transcatheter Aortic Valve Implementation (TAVI) to the cardiology units of the University Hospitals Leuven. The study uses a mixed-methods methodology aiming to 1) assess the feasibility and evaluate the effectiveness of geriatric co-management, 2) describe the experiences of intervention participants, and 3) perform a process evaluation. We will first consecutively recruit patients on the cardiology units to measure the standard of care in the control group. The geriatric co-management intervention will then be implemented and piloted on the participating units. Once fully implemented, we will consecutively recruit patients for the intervention group who will receive the geriatric co-management intervention.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
454
A comprehensive geriatric assessment on admission will stratify patients in groups: 1. Low risk patients are expected to do well and will not receive co-management. 2. Medium risk patients are expected to develop complications. A geriatric nurse will visit the cardiology wards daily to co-manage these patients aiming to prevent complications by coordinating interdisciplinary care, implementing protocols, perform assessments and bedside education. The geriatric nurse will work collaboratively with the cardiology ward staff based on a shared decision making. Patients will receive early rehabilitation and discharge planning. 3. High risk patients have an acute geriatric syndrome. The geriatric nurse will visit the cardiology wards (see above), and a geriatrician will co-manage the acute geriatric syndrome(s). The geriatrician will work collaboratively with the cardiology ward staff based on a shared decision making. Patients will receive early rehabilitation and discharge planning.
University Hospitals Leuven
Leuven, Vlaams-Brabant, Belgium
Functional status on activities of daily living assessed using the Katz Index of Activities of Daily Living.
A difference of 1 point on the Katz Index will be considered clinically relevant.
Time frame: Hospital admission (baseline) up to hospital discharge around an average of 12 days.
Functional decline in activities of daily living assessed using the Katz Index of Activities of Daily Living
A decline of 1 point between admission and discharge on the Katz Index will be considered clinically relevant.
Time frame: Hospital admission (baseline) up to hospital discharge around an average of 12 days.
Functional decline in activities of daily living assessed using the Barthel Index of Activities of daily. Living.
Time frame: Hospital admission (baseline), hospital discharge around an average of 12 days, and at 30 days, 3 months and 6 months follow-up after hospital discharge.
Community mobility assessed using the Life-Space assessment.
Time frame: Hospital admission (baseline), and at 30 days, 3 months and 6 months follow-up after hospital discharge.
Short Physical Performance Test (SPPB).
The SPPB consist of gait speed, balance test, and chair stand test.
Time frame: Hospital admission (baseline), up to at hospital discharge around an average of 12 days.
Peak handgrip force assessed at the dominant side with the elbow at 90° of flexion, and the forearm and wrist in a neutral position.
Isometric handgrip force will be measured with a hydraulic hand dynamometer (Jamar dynamometer; JA Preston Corporation; Jackson, MI).
Time frame: Hospital admission (baseline) up to hospital discharge around an average of 12 days.
Symptomatic infections defined by a clinical diagnosis of pneumonia, urinary tract infection, sepsis and wound infection.
Time frame: Hospital admission (baseline) up to hospital discharge around an average of 12 days.
Delirium assessed using the 3D confusion assessment method.
Time frame: Hospital admission (baseline) and on day 3, 5, 7 and 9 (or every day when a patient is delirious).
Cognitive status assessed using the Mini-Cog.
Time frame: Hospital admission (baseline) up to hospital discharge around an average of 12 days.
Falls and fall related injuries.
A fall incident is defined as an unexpected event in which the patient comes to rest on the ground, floor or lower level. Fall related injuries will be divided in two groups: minor and major.
Time frame: Hospital admission (baseline), hospital discharge around an average of 12 days, and at 30 days, 3 months and 6 months follow-up after hospital discharge.
Obstipation assessed using nurses recorded observations.
Obstipation is defined as not having passed stool in five days or more.
Time frame: Hospital admission (baseline) up to hospital discharge around an average of 12 days.
Length of hospital stay.
Time frame: Hospital admission (baseline) up to hospital discharge around an average of 12 days.
Institutionalization.
New admission to nursing home or skilled nursing facility
Time frame: hospital discharge around an average of 12 days, and at 30 days, 3 months and 6 months follow-up after hospital discharge.
Thirty day unplanned readmission rate.
Time frame: 30 days follow-up after hospital discharge.
Survival
Time to death
Time frame: Hospital discharge around an average of 12 days, and at 30 days, 3 months and 6 months follow-up after hospital discharge.
Quality of life assessed using the EQ-5D.
Time frame: Hospital admission (baseline), hospital discharge around an average of 12 days, and at 30 days, 3 months and 6 months follow-up after hospital discharge.
Quality of life index assessed by converting the EQ-5D using standardized index values.
Time frame: Hospital admission (baseline), hospital discharge around an average of 12 days, and at 30 days, 3 months and 6 months follow-up after hospital discharge.
Functional status on activities of daily living assessed using the Katz Index of Activities of Daily Living.
Functional status will be measured using the Katz Index of Activities of Daily Living.
Time frame: At 30 days, 3 months and 6 months follow-up after hospital discharge.
Unplanned hospital readmissions
Time to the first unplanned hospital readmission
Time frame: up to 6 months follow-up after hospital discharge
Hospital costs
Costs registered for to the treatment, care, logistics and stay in the hospital
Time frame: Between hospital admission and discharge, an average of 12 days
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