Optimization of a Transcatheter Aortic Valve Replacement programme: TAVR nurse protocol
Main Article Content
Abstract
Transcatheter aortic valve replacement has become the treatment of choice in aortic stenosis for high-risk patients and an effective and safe alternative in intermediate and low-risk cases. The success of the procedure, good outcomes, increasing indications and an ageing population have led to an exponential increase in transcatheter aortic valve replacement procedures, leading to the development of specifics programmes.
Our aim was to redesign our transcatheter aortic valve replacement programme by implementing a nurse role to improve the quality and efficiency in the clinical management of candidate patients. We developed a protocol based on comprehensive, coordinated and patient-centred care, with a multidisciplinary character, reinforcing the nurse role as coordinator-facilitator.
The nurse role was implemented in 2022 in our hospital. We described the responsibilities assumed by the nurse during pre-, intra- and post- transcatheter aortic valve replacement procedure phases. The main pillars were patient and family education, holistic assessment, as well as ensuring continuity of care by accompanying the patient and family throughout the entire process. The transition to a minimalist approach together with the implementation of an early discharge protocol has helped to reduce the hospital stay.
Developing patient-centred programmes and giving importance to information, education, accompaniment and management of patients' motivations and expectations helped to improve their satisfaction during the process. Monitoring the patient's perceived experience of the process allowed us to detect areas for improvement in order to move towards quality care.
Article Details
How to Cite
GONZÁLEZ-CEBRIAN, Miryam et al.
Optimization of a Transcatheter Aortic Valve Replacement programme: TAVR nurse protocol.
Medical Research Archives, [S.l.], v. 12, n. 10, oct. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5895>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v12i10.5895.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597–607. doi: 10.1056/NEJMoa1008232
2. Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187–98. doi:10.1056/NEJMoa1103510
3. Leon MB, Smith CR, Mack MJ, et al Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2016;374(17):1609–20. doi: 10.1056/NEJMoa1514616
4. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients. N Engl J Med. 2019;380(18):1695–705. doi: 10.1056/NEJMoa1814052
5. Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2017;376(14):1321–31. doi: 10.1056/NEJMoa1700456
6. Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients. N Engl J Med. 2019;380(18):1706–15. doi: 10.1056/NEJMoa1816885
7. Dworakowski R, MacCarthy PA, Monaghan M, et al. Transcatheter aortic valve implantation for severe aortic stenosis-A new paradigm for multidisciplinary intervention: a prospective cohort study. Am Heart J. 2010;160(2):237–43. doi: 10.1016/j.ahj.2010.05.014.
8. Thonghong T, De Backer O, Søndergaard L. Comprehensive update on the new indications for transcatheter aortic valve replacement in the latest 2017 European guidelines for the management of valvular heart disease. Open Heart. 2018;5(1):e000753. doi: 10.1136/openhrt-2017-000753.
9. Teresa Bastante, Dabit Arzamendi, Javier Martín-Moreiras, et al. Registro español de hemodinámica y cardiología intervencionista. XXXIII informe oficial de la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (1990-2023). Rev Esp Cardiología.2024, ISSN 0300-8932. doi.org/10.1016/j.recesp.2024.07.005.
10. Sabaté M, Cánovas S, García E, et al. Colaboradores del Grupo Nacional TAVI. Predictores de mortalidad intrahospitalaria y a medio plazo tras el implante percutáneo de válvula aórtica: datos del Registro Nacional TAVI 2010-2011. Rev Esp Cardiol (Ed. Inglesa) . 2013; 66 : 949–958. doi: 10.1016/j.rec.2013.07.003.
11. Núñez-Gil IJ, Elola J, García-Márquez M, et al. TAVI in the learning curve in Spain. In-hospital results compared with aortic valve replacement. REC: CardioClinics. 2021;56(4):242-9.
12. Jimenez-Quevedo P, Munoz-Garcia A, Trillo-Nouche R, et al. Time trend in transcatheter aortic valve implantation:an analysis of the Spanish TAVI registry. REC Interv Cardiol. 2020;2:98-105.
13. Íñiguez-Romo A, Javier Zueco-Gil J, Álvarez-Bartolomé M, et al. Outcomes of transcatheter aortic valve implantation in Spain through the Activity Registry of Specialized Health Care. REC Interv Cardiol. 2022;4:123-131
14. Bohmann K, Burgdorf C, Zeus T, et al. The COORDI-NATE Pilot Study: Impact of a Transcatheter Aortic Valve Coordinator Program on Hospital and Patient Outcomes. J Clin Med. 2022;11(5):1205.
15. De Ronde-Tillmans MJAG, Goudzwaard JA, El Faquir N, et al. TAVI Care and Cure, the Rotterdam multidisciplinary program for patients undergoing transcatheter aortic valve implantation: Design and rationale. Int J Cardiol. 2020;302:36-41. doi:10.1016/j.ijcard.2019.12.005
16. McCalmont G, Durand E, Lauck S, et al. Setting a benchmark for resource utilization and quality of care in patients undergoing transcatheter aortic valve implantation in Europe-rationale and design of the international BENCHMARK registry. Clin Cardiol.2021;44:1344–53. doi.org/10.1002/clc.23711
17. Wood DA, Lauck SB, Cairns JA, et al. The Vancouver 3M (Multidisciplinary, Multimodality, But Minimalist) Clinical Pathway Facilitates Safe Next-Day Discharge Home at Low-, Medium-, and High-Volume Transfemoral Transcatheter Aortic Valve Replacement Centers: The 3M TAVR Study. JACC Cardiovasc Interv. 2019;12(5):459-469. doi:10.1016/j.jcin.2018.12.020
18. Lauck SB, Wood DA, Baumbusch J, et al. Vancouver Transcatheter Aortic Valve Replacement Clinical Pathway: Minimalist Approach, Standardized Care, and Discharge Criteria to Reduce Length of Stay. Circ Cardiovasc Qual Outcomes. 2016;9(3):312-321. doi:10.1161/CIRCOUTCOMES.115.002541
19. Lauck SB, Sathananthan J, Park J, et al. Post-procedure protocol to facilitate next-day discharge: Results of the multidisciplinary, multimodality but minimalist TAVR study. Catheter Cardiovasc Interv. 2020;96(2):450-458. doi:10.1002/ccd.28617
20. Lauck SB, McCalmont G, Smith A, et al. Setting a Benchmark for Quality of Care: Update on Best Practices in Transcatheter Aortic Valve Replacement Programs. Crit Care Nurs Clin North Am. 2022;34(2):215-231. doi:10.1016/j.cnc.2022.02.009
21. Lauck SB, McGladrey J, Lawlor C, et al. Nursing leadership of the transcatheter aortic valve implantation Heart Team: Supporting innovation, excellence, and sustainability. Healthc Manage Forum.2016;29(3):126-130. doi:10.1177/0840470416632004
22. Hawkey MC, Lauck SB, Perpetua EM, et al. Transcatheter aortic valve replacement program development: recommendations for best practice. Catheter Cardiovasc Interv. 2014;84(6):859-867. doi:10.1002/ccd.25529
23. González-Cebrian M, Valverde Bernal J, Bajo Arambarri E, et al. Documento de consenso de la figura de la TAVI Nurse del Grupo de Trabajo de Hemodinámica de la Asociación Española de Enfermería en Cardiología. Enferm Cardiol. 2022;29(86): 5-13.
24. González-Cebrian M, Alonso-Fernández de Gatta M, Carreño Sánchez R, et al. Nursing-Guided Pre-Procedural Preparation In Patients Undergoing Transcatheter Aortic Valve Replacement. Int J Nurs Health Care Res.2022;5:1354 .doi:10.29011/2688-9501.101354
25. Ternacle J, Krapf L, Mohty D, et al. Aortic Stenosis and Cardiac Amyloidosis: JACC Review Topic of the Week. J Am Coll Cardiol. 2019;74(21):2638-2651. doi:10.1016/j.jacc.2019.09.05
26. Nitsche C, Scully PR, Patel KP, et al. Prevalence and Outcomes of Concomitant Aortic Stenosis and Cardiac Amyloidosis. J Am Coll Cardiol. 2021;77(2):128-139. doi:10.1016/j.jacc.2020.11.006
27. Black N, Varaganum M, Hutchings A. Relationship between patient reported experience (PREMs) and patient reported outcomes (PROMs) in elective surgery. BMJ Qual Saf. 2014;23(7):534-542. doi:10.1136/bmjqs-2013-002707
28. Valera Rodriguez C, Ruiz Lopez PM, Pérez González A, et al. Guía para el diseño, implementación y medición de la experiencia del paciente en los hospitales mediante PREM. Patients reported experience measurements. Madrid: Asociación Madrileña de calidad asistencial. 2022. ISBN 987-84-09-41139-9.
29. Escarrabill J, Almazán C, Barrionuevo-Rosas L, et al. Elementos clave que influyen en la experiencia del paciente Patients reported experience measurements (PREM). Barcelona: Agencia de Calidad y Evaluación Sanitarias de Cataluña. Departamento de Salud. Generalitat de Cataluña.2020.
30. Wood DA, Lauck SB, Cairns JA, et al. The Vancouver 3M (Multidisciplinary, Multimodality, But Minimalist) Clinical Pathway Facilitates Safe Next-Day Discharge Home at Low-, Medium-, and High-Volume Transfemoral Transcatheter Aortic Valve Replacement Centers: The 3M TAVR Study. JACC Cardiovasc Interv. 2019;12(5):459-469. doi:10.1016/j.jcin.2018.12.020
31. Barbanti M, van Mourik MS, Spence MS, et al. Optimising patient discharge management after transfemoral transcatheter aortic valve implantation: the multicentre European FAST-TAVI trial. EuroIntervention. 2019;15(2):147-154. doi:10.4244/EIJ-D-18-01197
32. Durand E, Beziau-Gasnier D, Michel M, et al. Reducinglength of stay after transfemoral transcatheter aortic valve implantation: the FAST-TAVI II trial. Eur Heart J.2024;45:952–62. doi.org/10.1093/eurheartj/ehae081
33. Lauck SB, Wood DA, Baumbusch J, et al. Vancouver Transcatheter Aortic Valve Replacement Clinical Pathway: Minimalist Approach, Standardized Care, and Discharge Criteria to Reduce Length of Stay. Circ Cardiovasc Qual Outcomes. 2016;9(3):312-321. doi:10.1161/CIRCOUTCOMES.115.002541
34. Lauck SB, Sathananthan J, Park J, et al. Post-procedure protocol to facilitate next-day discharge: Results of the multidisciplinary, multimodality but minimalist TAVR study. Catheter Cardiovasc Interv. 2020;96(2):450-458. doi:10.1002/ccd.28617
35. McCalmont G, Arshad M, Bawamia B, et al. Impact of a nurse-led same day admission pathway on hospital length of stay for transcatheter aortic valve implantation. British Journal of Cardiac Nursing. 2020;15(6):1–7
36. Costa G, Barbanti M, Picci A, et al. Predictors and safety of next-day discharge in patients undergoing transfemoral transcatheter aortic valve implantation. EuroIntervention. 2020;16(6):e494-e501. doi:10.4244/EIJ-D-19-01080
37. Chopra M, Luk NHV, De Backer O, et al. Simplification and optimization of transcatheter aortic valve implantation - fast-track course without compromising safety and efficacy. BMC Cardiovasc Disord. 2018;18(1):231. Published 2018 Dec 10. doi:10.1186/s12872-018-0976-0
2. Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187–98. doi:10.1056/NEJMoa1103510
3. Leon MB, Smith CR, Mack MJ, et al Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2016;374(17):1609–20. doi: 10.1056/NEJMoa1514616
4. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients. N Engl J Med. 2019;380(18):1695–705. doi: 10.1056/NEJMoa1814052
5. Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2017;376(14):1321–31. doi: 10.1056/NEJMoa1700456
6. Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients. N Engl J Med. 2019;380(18):1706–15. doi: 10.1056/NEJMoa1816885
7. Dworakowski R, MacCarthy PA, Monaghan M, et al. Transcatheter aortic valve implantation for severe aortic stenosis-A new paradigm for multidisciplinary intervention: a prospective cohort study. Am Heart J. 2010;160(2):237–43. doi: 10.1016/j.ahj.2010.05.014.
8. Thonghong T, De Backer O, Søndergaard L. Comprehensive update on the new indications for transcatheter aortic valve replacement in the latest 2017 European guidelines for the management of valvular heart disease. Open Heart. 2018;5(1):e000753. doi: 10.1136/openhrt-2017-000753.
9. Teresa Bastante, Dabit Arzamendi, Javier Martín-Moreiras, et al. Registro español de hemodinámica y cardiología intervencionista. XXXIII informe oficial de la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (1990-2023). Rev Esp Cardiología.2024, ISSN 0300-8932. doi.org/10.1016/j.recesp.2024.07.005.
10. Sabaté M, Cánovas S, García E, et al. Colaboradores del Grupo Nacional TAVI. Predictores de mortalidad intrahospitalaria y a medio plazo tras el implante percutáneo de válvula aórtica: datos del Registro Nacional TAVI 2010-2011. Rev Esp Cardiol (Ed. Inglesa) . 2013; 66 : 949–958. doi: 10.1016/j.rec.2013.07.003.
11. Núñez-Gil IJ, Elola J, García-Márquez M, et al. TAVI in the learning curve in Spain. In-hospital results compared with aortic valve replacement. REC: CardioClinics. 2021;56(4):242-9.
12. Jimenez-Quevedo P, Munoz-Garcia A, Trillo-Nouche R, et al. Time trend in transcatheter aortic valve implantation:an analysis of the Spanish TAVI registry. REC Interv Cardiol. 2020;2:98-105.
13. Íñiguez-Romo A, Javier Zueco-Gil J, Álvarez-Bartolomé M, et al. Outcomes of transcatheter aortic valve implantation in Spain through the Activity Registry of Specialized Health Care. REC Interv Cardiol. 2022;4:123-131
14. Bohmann K, Burgdorf C, Zeus T, et al. The COORDI-NATE Pilot Study: Impact of a Transcatheter Aortic Valve Coordinator Program on Hospital and Patient Outcomes. J Clin Med. 2022;11(5):1205.
15. De Ronde-Tillmans MJAG, Goudzwaard JA, El Faquir N, et al. TAVI Care and Cure, the Rotterdam multidisciplinary program for patients undergoing transcatheter aortic valve implantation: Design and rationale. Int J Cardiol. 2020;302:36-41. doi:10.1016/j.ijcard.2019.12.005
16. McCalmont G, Durand E, Lauck S, et al. Setting a benchmark for resource utilization and quality of care in patients undergoing transcatheter aortic valve implantation in Europe-rationale and design of the international BENCHMARK registry. Clin Cardiol.2021;44:1344–53. doi.org/10.1002/clc.23711
17. Wood DA, Lauck SB, Cairns JA, et al. The Vancouver 3M (Multidisciplinary, Multimodality, But Minimalist) Clinical Pathway Facilitates Safe Next-Day Discharge Home at Low-, Medium-, and High-Volume Transfemoral Transcatheter Aortic Valve Replacement Centers: The 3M TAVR Study. JACC Cardiovasc Interv. 2019;12(5):459-469. doi:10.1016/j.jcin.2018.12.020
18. Lauck SB, Wood DA, Baumbusch J, et al. Vancouver Transcatheter Aortic Valve Replacement Clinical Pathway: Minimalist Approach, Standardized Care, and Discharge Criteria to Reduce Length of Stay. Circ Cardiovasc Qual Outcomes. 2016;9(3):312-321. doi:10.1161/CIRCOUTCOMES.115.002541
19. Lauck SB, Sathananthan J, Park J, et al. Post-procedure protocol to facilitate next-day discharge: Results of the multidisciplinary, multimodality but minimalist TAVR study. Catheter Cardiovasc Interv. 2020;96(2):450-458. doi:10.1002/ccd.28617
20. Lauck SB, McCalmont G, Smith A, et al. Setting a Benchmark for Quality of Care: Update on Best Practices in Transcatheter Aortic Valve Replacement Programs. Crit Care Nurs Clin North Am. 2022;34(2):215-231. doi:10.1016/j.cnc.2022.02.009
21. Lauck SB, McGladrey J, Lawlor C, et al. Nursing leadership of the transcatheter aortic valve implantation Heart Team: Supporting innovation, excellence, and sustainability. Healthc Manage Forum.2016;29(3):126-130. doi:10.1177/0840470416632004
22. Hawkey MC, Lauck SB, Perpetua EM, et al. Transcatheter aortic valve replacement program development: recommendations for best practice. Catheter Cardiovasc Interv. 2014;84(6):859-867. doi:10.1002/ccd.25529
23. González-Cebrian M, Valverde Bernal J, Bajo Arambarri E, et al. Documento de consenso de la figura de la TAVI Nurse del Grupo de Trabajo de Hemodinámica de la Asociación Española de Enfermería en Cardiología. Enferm Cardiol. 2022;29(86): 5-13.
24. González-Cebrian M, Alonso-Fernández de Gatta M, Carreño Sánchez R, et al. Nursing-Guided Pre-Procedural Preparation In Patients Undergoing Transcatheter Aortic Valve Replacement. Int J Nurs Health Care Res.2022;5:1354 .doi:10.29011/2688-9501.101354
25. Ternacle J, Krapf L, Mohty D, et al. Aortic Stenosis and Cardiac Amyloidosis: JACC Review Topic of the Week. J Am Coll Cardiol. 2019;74(21):2638-2651. doi:10.1016/j.jacc.2019.09.05
26. Nitsche C, Scully PR, Patel KP, et al. Prevalence and Outcomes of Concomitant Aortic Stenosis and Cardiac Amyloidosis. J Am Coll Cardiol. 2021;77(2):128-139. doi:10.1016/j.jacc.2020.11.006
27. Black N, Varaganum M, Hutchings A. Relationship between patient reported experience (PREMs) and patient reported outcomes (PROMs) in elective surgery. BMJ Qual Saf. 2014;23(7):534-542. doi:10.1136/bmjqs-2013-002707
28. Valera Rodriguez C, Ruiz Lopez PM, Pérez González A, et al. Guía para el diseño, implementación y medición de la experiencia del paciente en los hospitales mediante PREM. Patients reported experience measurements. Madrid: Asociación Madrileña de calidad asistencial. 2022. ISBN 987-84-09-41139-9.
29. Escarrabill J, Almazán C, Barrionuevo-Rosas L, et al. Elementos clave que influyen en la experiencia del paciente Patients reported experience measurements (PREM). Barcelona: Agencia de Calidad y Evaluación Sanitarias de Cataluña. Departamento de Salud. Generalitat de Cataluña.2020.
30. Wood DA, Lauck SB, Cairns JA, et al. The Vancouver 3M (Multidisciplinary, Multimodality, But Minimalist) Clinical Pathway Facilitates Safe Next-Day Discharge Home at Low-, Medium-, and High-Volume Transfemoral Transcatheter Aortic Valve Replacement Centers: The 3M TAVR Study. JACC Cardiovasc Interv. 2019;12(5):459-469. doi:10.1016/j.jcin.2018.12.020
31. Barbanti M, van Mourik MS, Spence MS, et al. Optimising patient discharge management after transfemoral transcatheter aortic valve implantation: the multicentre European FAST-TAVI trial. EuroIntervention. 2019;15(2):147-154. doi:10.4244/EIJ-D-18-01197
32. Durand E, Beziau-Gasnier D, Michel M, et al. Reducinglength of stay after transfemoral transcatheter aortic valve implantation: the FAST-TAVI II trial. Eur Heart J.2024;45:952–62. doi.org/10.1093/eurheartj/ehae081
33. Lauck SB, Wood DA, Baumbusch J, et al. Vancouver Transcatheter Aortic Valve Replacement Clinical Pathway: Minimalist Approach, Standardized Care, and Discharge Criteria to Reduce Length of Stay. Circ Cardiovasc Qual Outcomes. 2016;9(3):312-321. doi:10.1161/CIRCOUTCOMES.115.002541
34. Lauck SB, Sathananthan J, Park J, et al. Post-procedure protocol to facilitate next-day discharge: Results of the multidisciplinary, multimodality but minimalist TAVR study. Catheter Cardiovasc Interv. 2020;96(2):450-458. doi:10.1002/ccd.28617
35. McCalmont G, Arshad M, Bawamia B, et al. Impact of a nurse-led same day admission pathway on hospital length of stay for transcatheter aortic valve implantation. British Journal of Cardiac Nursing. 2020;15(6):1–7
36. Costa G, Barbanti M, Picci A, et al. Predictors and safety of next-day discharge in patients undergoing transfemoral transcatheter aortic valve implantation. EuroIntervention. 2020;16(6):e494-e501. doi:10.4244/EIJ-D-19-01080
37. Chopra M, Luk NHV, De Backer O, et al. Simplification and optimization of transcatheter aortic valve implantation - fast-track course without compromising safety and efficacy. BMC Cardiovasc Disord. 2018;18(1):231. Published 2018 Dec 10. doi:10.1186/s12872-018-0976-0