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LIFE AFTER TAVI: EXPLORING PATIENTS' PERCEIVED HEALTH STATUS AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION
CCCN Abstracts
NP037 EVALUATION OF A NURSE PRACTITIONER LED OUTPATIENT CHEST PAIN PROGRAM CLINIC AT THE MAZANKOWSKI ALBERTA HEART INSTITUTE: A FOLLOW-UP J Thomas1, L Jensen2, K Bainey1 1 Mazankowski Alberta Heart Institute, Edmonton, AB, 2 University of Alberta, Edmonton, AB
Key initiatives jointly developed by the Government of Alberta and Alberta Health Services include improving cardiac health of Albertans, reducing stay in Emergency Departments for discharged patients, and providing a patientfocused health system that is accessible and sustainable for all Albertans. This is partly achieved by establishing clinical pathways to assist patient movement towards best possible outcomes, as well as expanding the scope of practice of Nurse Practitioners (NP).The Chest Pain Program Clinic (CPPC) was established in 2012, as a NP led outpatient clinic at the Mazankowski Alberta Heart Institute, Edmonton, Alberta, within a collaborative practice model. Observations regarding prevalence of cardiovascular risk factors in this cohort, Emergency Department wait times, and continuing challenges facing the NP role will be presented. Findings suggest that the majority of patients were in the high risk category as per Framingham Risk Score, and had 2 or more risk factors for heart disease. Majority of the patients were discharged from the Emergency Departments within 8 hours of admission. Multiple challenges continue to exist for NP practice, and recommendations to possibly reduce these will be highlighted.
NP038 LIFE AFTER TAVI: EXPLORING PATIENTS’ PERCEIVED HEALTH STATUS AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION L Achtem1, S Lauck1, E Garland1, J Baumbusch2 1
St. Pauls’ Hospital, Vancouver, BC,, 2 University of British Columbia, Vancouver, BC
Transcatheter aortic valve implantation (TAVI) is the recommended therapy for patients with severe aortic stenosis at high or excessive risk for surgery and likely to gain significant benefit. Careful case selection informed by a comprehensive multimodality and multidisciplinary Heart Team assessment is pivotal to ensure excellent outcomes. The eligibility decision incorporates the findings of a functional assessment that captures the physical, social and mental dimensions of frailty, overall function and quality of life. These measures are repeated in the follow-up evaluation at the procedure site to measure patients’ derived benefit. This presentation will describe the findings of an exploratory assessment of patients’ self-reported perceived health status one to two months after TAVI. We will report the change in the standardized measures utilized to quantify overall health status and symptom burden measured by the Edmonton Symptom Assessment Survey
S377
(ESAS-r). Based on the interactions with the TAVI Nurse Coordinator, we will describe the themes emerging from questions centred on patients’ views of their decision to have TAVI and their reflections on their early recovery. Although clinical trials continue to examine the survival and morbidity benefits of TAVI as a treatment option for high risk and mostly elderly patients, patients’ self-reported evaluation of their health status gains or unmet expectations must be considered in program and outcome evaluation. Early exploratory reports will inform future research and support nursing practice
NP039 ADVANCING CARDIAC SERVICES - SUCCESSES AND LESSONS LEARNED (PERCUTANEOUS CORONARY INTERVENTION FOR CHRONIC TOTAL OCCLUSION) D Pynn, G Boatswain, Y Shin, R Gonsalves, F Nanji, C Chimonides, M Finley RVHS, Toronto, ON
Coronary Chronic Total Occlusion (CTO) is a complete or almost complete blockage of a coronary artery for 30 or more days. CTO is caused by a heavy build-up of atherosclerotic plaque within the artery. The prevalence in non-selected diagnostic coronary angiograms is reported to be as high as 30%. Percutaneous Coronary Intervention (PCI) of CTO may result in improvement in symptoms, and overall improvement in survival. Many patients with CTO are selected for bypass surgery or, in cases where bypass has already occurred and failed, or is not appropriate, suffer ongoing angina and limitation with medical therapy alone. As the leader in Cardiac Care services in Ontario, Rouge Valley Health System (RVHS) is committed to meeting the cardiac care needs of its population in the Central East LHIN. RVHS’s priority is to provide safe, efficient, and seamless quality care for patients. The PCI-CTO service provided RVHS with an opportunity to further meet the needs of this population by providing access to a specialized service, closer to home. Implementation of the PCI-CTO service involved careful planning using Lean methodology in conjunction with a project framework approach, actions taken included: extensive education and training for physicians and nurses; mentorship from an experienced physician; policy/procedures and order set development; monitoring and outcome reporting; and patient satisfaction follow up. The purpose of this abstract is to share our experience (and tools developed) in expanding our PCI service; highlighting successes and lessons learned with other cardiac teams, who also strive to enhance timely access to specialized services close to home, and improve performance and clinical outcomes while enhancing patient’s experience and satisfaction.
NP037 EVALUATION OF A NURSE PRACTITIONER LED OUTPATIENT CHEST PAIN PROGRAM CLINIC AT THE MAZANKOWSKI ALBERTA HEART INSTITUTE: A FOLLOW-UP J Thomas1, L Jensen2, K Bainey1 1 Mazankowski Alberta Heart Institute, Edmonton, AB, 2 University of Alberta, Edmonton, AB
Key initiatives jointly developed by the Government of Alberta and Alberta Health Services include improving cardiac health of Albertans, reducing stay in Emergency Departments for discharged patients, and providing a patientfocused health system that is accessible and sustainable for all Albertans. This is partly achieved by establishing clinical pathways to assist patient movement towards best possible outcomes, as well as expanding the scope of practice of Nurse Practitioners (NP).The Chest Pain Program Clinic (CPPC) was established in 2012, as a NP led outpatient clinic at the Mazankowski Alberta Heart Institute, Edmonton, Alberta, within a collaborative practice model. Observations regarding prevalence of cardiovascular risk factors in this cohort, Emergency Department wait times, and continuing challenges facing the NP role will be presented. Findings suggest that the majority of patients were in the high risk category as per Framingham Risk Score, and had 2 or more risk factors for heart disease. Majority of the patients were discharged from the Emergency Departments within 8 hours of admission. Multiple challenges continue to exist for NP practice, and recommendations to possibly reduce these will be highlighted.
NP038 LIFE AFTER TAVI: EXPLORING PATIENTS’ PERCEIVED HEALTH STATUS AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION L Achtem1, S Lauck1, E Garland1, J Baumbusch2 1
St. Pauls’ Hospital, Vancouver, BC,, 2 University of British Columbia, Vancouver, BC
Transcatheter aortic valve implantation (TAVI) is the recommended therapy for patients with severe aortic stenosis at high or excessive risk for surgery and likely to gain significant benefit. Careful case selection informed by a comprehensive multimodality and multidisciplinary Heart Team assessment is pivotal to ensure excellent outcomes. The eligibility decision incorporates the findings of a functional assessment that captures the physical, social and mental dimensions of frailty, overall function and quality of life. These measures are repeated in the follow-up evaluation at the procedure site to measure patients’ derived benefit. This presentation will describe the findings of an exploratory assessment of patients’ self-reported perceived health status one to two months after TAVI. We will report the change in the standardized measures utilized to quantify overall health status and symptom burden measured by the Edmonton Symptom Assessment Survey
S377
(ESAS-r). Based on the interactions with the TAVI Nurse Coordinator, we will describe the themes emerging from questions centred on patients’ views of their decision to have TAVI and their reflections on their early recovery. Although clinical trials continue to examine the survival and morbidity benefits of TAVI as a treatment option for high risk and mostly elderly patients, patients’ self-reported evaluation of their health status gains or unmet expectations must be considered in program and outcome evaluation. Early exploratory reports will inform future research and support nursing practice
NP039 ADVANCING CARDIAC SERVICES - SUCCESSES AND LESSONS LEARNED (PERCUTANEOUS CORONARY INTERVENTION FOR CHRONIC TOTAL OCCLUSION) D Pynn, G Boatswain, Y Shin, R Gonsalves, F Nanji, C Chimonides, M Finley RVHS, Toronto, ON
Coronary Chronic Total Occlusion (CTO) is a complete or almost complete blockage of a coronary artery for 30 or more days. CTO is caused by a heavy build-up of atherosclerotic plaque within the artery. The prevalence in non-selected diagnostic coronary angiograms is reported to be as high as 30%. Percutaneous Coronary Intervention (PCI) of CTO may result in improvement in symptoms, and overall improvement in survival. Many patients with CTO are selected for bypass surgery or, in cases where bypass has already occurred and failed, or is not appropriate, suffer ongoing angina and limitation with medical therapy alone. As the leader in Cardiac Care services in Ontario, Rouge Valley Health System (RVHS) is committed to meeting the cardiac care needs of its population in the Central East LHIN. RVHS’s priority is to provide safe, efficient, and seamless quality care for patients. The PCI-CTO service provided RVHS with an opportunity to further meet the needs of this population by providing access to a specialized service, closer to home. Implementation of the PCI-CTO service involved careful planning using Lean methodology in conjunction with a project framework approach, actions taken included: extensive education and training for physicians and nurses; mentorship from an experienced physician; policy/procedures and order set development; monitoring and outcome reporting; and patient satisfaction follow up. The purpose of this abstract is to share our experience (and tools developed) in expanding our PCI service; highlighting successes and lessons learned with other cardiac teams, who also strive to enhance timely access to specialized services close to home, and improve performance and clinical outcomes while enhancing patient’s experience and satisfaction.