University of Twente Student Theses
Improving objective decision making in the TAVI pathway : Assessing the impact of next-day discharge and evaluating a risk prediction model
Schepers, L.A.N. (2024) Improving objective decision making in the TAVI pathway : Assessing the impact of next-day discharge and evaluating a risk prediction model.
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| Abstract: | Introduction: Patients with severe symptomatic aortic valve stenosis undergoing transcatheter aortic valve implantation (TAVI) are subject to various protocols for risk assessment and post-procedural care. This study aimed to enhance the TAVI pathway by developing a risk prediction model and implementing fast-track protocols combined with ambulatory monitoring for post-procedural care. Methods and Results: The study consisted of 3 studies: • Next-Day Discharge: This study evaluated a next-day discharge protocol in a cohort of 131 TAVI patients, divided into NDD+ (56 patients eligible for next-day discharge) and NDD- (95 patients ineligible). No significant differences were observed in complications, rehospitalizations, mortality, change in NYHA class, or change in quality of life. However, a significant difference in the composite endpoint favored the NDD+ arm, suggesting that next-day discharge is safe and effective. • Ambulatory Monitoring: A review of monitoring systems identified Senselink, Zenicor ECG, and Kardia Mobile-HartWacht as promising options for post-procedural TAVI care. • Risk prediction model: A risk prediction model was developed using the CENTER2 database (24,322 patients) with a logistic regression and feature selection through wrapper-backward elimination using decision trees. The model showed a suboptimal performance, with an AUROC of 0.59 on the validation set, indicating limited predictive accuracy. Conclusion: The risk prediction model demonstrated limited clinical utility, with an AUROC of 0.59 for 30-day mortality prediction. Despite the lack of improvement in risk assessment, significant advancements were made in streamlining post-procedural care. The next-day discharge study successfully facilitated the discharge of 50% of eligible patients within 24 hours, thereby improving patient comfort by enabling home recovery. No disadvantages of next-day discharge were found, as the only significant statistical difference favored the NDD+ arm. Additionally, various options for ambulatory monitoring have been explored, with the potential implementation of HartWacht allowing for same-day discharge and enhanced patient safety. |
| Item Type: | Essay (Master) |
| Clients: | AmsterdamUMC, Amsterdam, Netherlands |
| Faculty: | TNW: Science and Technology |
| Subject: | 44 medicine |
| Programme: | Technical Medicine MSc (60033) |
| Link to this item: | https://purl.utwente.nl/essays/103334 |
| Export this item as: | BibTeX EndNote HTML Citation Reference Manager |
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