The Structural Heart Disease Patient Experience Jennifer Dollery RN, BSN Structural Heart Disease Program Manager The Ohio State University Wexner Medical Center 1 Who is our TAVR population? 2 Early TAVR Experience Elderly Patients Multiple Comorbidities High Risk or Prohibitive Risk for Surgery Investigational Devices Present TAVR Experience Younger Patients as well as Elderly Less Comorbidities Low Risk to Prohibitive Risk Mix Commercially Approved Devices & Investigational Devices Evolution of Structural Heart Procedures Peri-Valvular Leak Closure ASD & VSD Closures MitraClip Procedure. 1
Our patient experience begins with YOU! Referring Physician is an Integral Part of our Team & The Patient Experience Foundational Relationship of Trust Provide Initial Insight into OSU Experience Provide Initial Education on Possible Procedure & evaluation process 3 Referral to OSUWMC SHD Program Referral Line 614-366-0586 Patients are referred to our office and contacted by the SHD office to discuss their appointment with our multidisciplinary structural heart disease team and any additional testing they will have that day. Our patients will have multiple tests prior to their actual procedure. Most testing can be completed at their local facility of choice to make the process easier for patients and families. 4 2
New Patient Packet A new Patient Packet is mailed to every patient and includes: 1. SHD office contact information and patient appointment letter 2. Health history & medications form 3. Kansas City Cardiomyopathy Questionnaire 4. Reference material supporting the Aortic/Mitral procedure and testing 5 Pre-Operative Testing for Structural Heart Procedures 6 3
Appointment Day #1 The first day we meet your patient is typically the beginning of a year (or longer) relationship with our team. During The First Visit Collection of History Forms & QOL Questionnaire Evaluate Symptoms & Disease Progression 7 Appointment Day #1 cont. Detailed Education is Provided to Patient & Family What is aortic stenosis/mitral regurgitation? Procedure Explanation Pre-Operative Testing Reviewed Frailty Testing Performed KCCQ Katz Daily Living Mini-Mental Exam Hand Grip 15m Walk/6 min Walk 8 4
Appointment Day #1 cont. Physician Evaluation Cardiac Surgeon Interventional Cardiologist Consent Signed Patient Photographed Next Steps 9 Appointment Day #2 (if indicated) 2 nd Surgical Evaluation The FDA and NCDR require the all patients that are evaluated for the TAVR procedure see 2 surgeons face to face and they agree that the patient is low, intermediate, high or prohibitive risk for open heart surgery. 2 nd surgical Evaluation can be done at OSU or Locally by a Cardiac Surgeon Completion of Remaining Diagnostic Testing Laboratory Testing Type & Cross Match 10 5
Structural Heart Committee Meeting All Diagnostic Testing Reviewed Procedural Planning Discuss Additional Medical Issues or Evaluation Needed Hematologic Issues Oncologic Issues Neurologic Issues Schedule Patient & Mail Procedure Letter 11 Patients arrive 2-3 hours prior to the scheduled procedure time. Procedure Day All patients scheduled for aortic or mitral procedures arrive the day of procedure. Procedures can last anywhere from 1 hour to 4 hours depending on the structural procedure being performed. All TAVR patients recover in the PACU and lay flat for 4 hours post procedure. Patients are then moved to the Ross Heart Hospital where they stay until discharge. 12 6
Post procedure we immediately begin the preparing our patients for discharge. Post Procedure Length of stay varies per patient. Average length of stay is 2.5 days in the hospital. They are expected to be up in the chair for all meals. They walk 3-4 times per day. A Gerontology referral is placed on all SHD patients post procedure for evaluation & support. Patients are discharged home as much as possible to stay with family or have HHC. 13 When patients are discharged we encourage all of them to follow up with their local cardiologist and PCP within 2 weeks of discharge. Post Discharge Commercially treated patients are seen at 30 days and 1 year for follow up. We see them back in our office at 30 days and 1 year. They complete an EKG, lab work, echocardiogram and the KCCQ questionnaire at each visit. After that 1 year appointment we no longer need to see them unless they are in a research trial or need continued support. 14 7
Our Structural Heart Team thanks YOU for your continued support. go.osu.edu/structuralheart 15 8