SPC365

Telemonitoring Aortic valvular Intervention Waiting List Patients Prognostic Value

Session: Comunicações Orais - Sessão 19 - Saúde Digital e Economia da Saúde
Speaker: António Maria Rocha de Almeida

Congress: CPC 2023
Topic: N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
Theme: 15. Valvular Heart Disease
Subtheme: 15.2 Valvular Heart Disease – Epidemiology, Prognosis, Outcome
Session Type: Comunicações Orais
FP Number: ---
Authors: António Maria Rocha De Almeida; Miguel Carias Sousa; Cláudia Magro; Liliana Boieiro; Sandra Sofia; Rita Rocha; Francisco Cláudio; Marta Paralta Figueiredo; Kisa Congo; Lino Patrício

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Aortic stenosis is the most common valve disease requiring intervention. Severe aortic stenosis has very poor prognosis and early intervention is strongly recommended. However, the pathway needs to be optimized.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">According to a single clinical risk stratification, the intervention is scheduled, and the patient is listed in the waiting list. To prevent significant clinical and prognosis deterioration while waiting, a telemonitoring program was started, associated with a fast-track pathway to intervention. </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Telemonitoring program included vital signs, ECG, weight, and symptomatic daily assessment. It required the input of the parameters on platform. Weekly, each patient was contacted to verify his status. The monitoring continued one after month for follow-up.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">This study aims to evaluate the prognostic value of the telemonitoring program in management of aortic valve intervention waiting list patients.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Retrospective cohort of 125 patients listed to aortic valve intervention was divided into two groups: one that were on telemonitoring program, of 40 patients, and other of 110 patients that were traditionally schedule, for 18 months. </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Population of both groups were not statistical significantly different in terms of age or sex distribution (p&gt;0,05). Of the 125 patients, 108 were subjected to TAVI, 2 to surgical aortic valve replacement.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The median waiting time on telemonitored group was 36 days [IR 46], with 3 deaths (7,5%), 2 of cardiovascular cause (5%). 6 patients (23%) were anticipated due to worsening of symptoms: 1 syncope (2,5%), 1 chest pain (2,5%), and 4 dyspnea (2,5%). None was hospitalized while waiting. </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The median waiting time on non-monitored group was 66 [IR 23] days, with 15 deaths (18%), 3 (4%) of cardiovascular, 6 (7%) of non-cardiovascular and 6 (7%) of unknown cause. 6 (7%) patients were hospitalized when they were listed for TAVI and 4 (5%) were previously listed and were hospitalized when TAVI was performed.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">There was a statistically significant decrease of mortality and hospitalization in the telemonitored group (p=0,05). There was also a statistically significant shorter period of waiting time on the telemonitored group (p&lt;0,05), due to the anticipation of more symptomatic patients.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The telemonitoring allows the clinical reassessment and re-stratification of the patients on the waiting list. It permits a constant optimization and a dynamically reorganization of the waiting list, verifying whom might benefit more of an earlier intervention, to apply the fast-track pathway.</span></span></p>