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Canadian Journal of Cardiology

USE OF A DIGITAL APPLICATION TO OPTIMIZE THE CLINICAL TRAJECTORY OF PATIENTS IN A TAVI PROGRAM

      Background

      We used a digital application available on smartphones which helps health care professionals educate, engage and monitor patients through surgery outside the walls of the hospital. The aim of this study was to evaluate the impact of digital application use on patient’s clinical trajectory, on patient’s reported outcomes and on the reduction of health service utilization in a transcatheter aortic valve implantation (TAVI) program.

      Methods and Results

      This platform was introduced in the TAVI program at the Montréal Heart Institute (MHI) in December 2020. Patients were engaged in the digital program at their visit to the clinic. They received notifications and health surveys 2 days before the procedure to ensure they were ready for the procedure and then daily for 7 days to follow their clinical trajectory. Based on their answers, patients either received self-education and self-management tips or were redirected to the program's nurse coordinator. Follow-up surveys and Kansas City Cardiomyopathy Questionnaire (KCCQ12) were sent to patients at 1, 3, 6 and 12 months to evaluate their functional recovery. 227 patients underwent a TAVI procedure at the MHI from December 2020 to November 2021. 99 patients (44%) accepted to use the application and formed the digital application group. The two groups (digital application group and non-digital application group) were comparable in terms of age (76 years old (72. 81) vs 77 years old (71.82)), STS (Society of Thoracic Surgeons’ risk model) score (6.1% vs 6.7%), vascular complications (8.1 vs 7.8%) and post procedure pacemakers (10.1% vs 10.9%). In the digital application group, 93 % recommended the application, 95% said it helped them feel more confident before the procedure and 84% felt more confident after the procedure. Digital application use helped to reduce emergency visits by 33.5% (7.9 vs 11.9%) and readmission rates related to the procedure by 50.1% (7.9% vs 15.9%) in the month following a TAVI procedure.

      Conclusion

      Patients were largely satisfied with the digital application which helped to guide them before and after their cardiac intervention and helped to reduce health services utilization by avoiding hospital readmissions and emergency visits following a TAVI procedure. Our findings also suggest that digital application to optimize patient’s clinical trajectory is feasible in an aging population.