Year of Publication

2016

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Sheila Melander

Clinical Mentor

Dr. Elizabeth Burckardt

Committee Member

Dr. Vicki Turner

Abstract

Purpose: The purpose of this study was to conduct an initial needs assessment on the TAVR program at Norton Healthcare (NHC). Baseline data were collected on patient quality of life as evidenced by Kansas City Cardiomyopathy Questionnaire (KCCQ) scores, frailty scores, Katz index, Lawton scale, Society of Thoracic Surgeons (STS) mortality score, and comorbidities. A secondary purpose was to identify trends in patient outcomes such as increased morbidity, mortality, readmission rates, complications, discharge disposition, and increased length of stay.

Setting and Population: The population for this study was all patients at Norton Audubon Hospital (NAH) who underwent TAVR between October 1, 2014 and December 31, 2015. A total of 51 patients were included in the chart review.

Procedures: This needs assessment utilized a retrospective electronic medical record review. The records were assigned a study number that was used on all electronic data collection forms. Data were collected using an investigator developed data collection instrument. The data were then directly entered into Data Analysis Statistical Package for the Social Sciences (SPSS) software for analysis.

Results and Conclusions: A review of the patients’ health history and co-morbid burden was conducted. Forty-three patients (84.3%) had hypertension, 33 (64.7%) had coronary artery disease or a myocardial infarction, 37 (72.5%) had hyperlipidemia, nine (17.6%) had a permanent pacemaker and/or AICD, 14 (27.5%) had previous coronary artery bypass grafting (CABG), 24 (47.1%) had an arrhythmia such as atrial fibrillation, 11 (21.6%) had a previous stroke, 26 (51%) had some form of pulmonary disease, 16 (31.4%) had some form of renal disease, 12 (23.5%) had history of cancer, and 13 (25.5%) were diabetic. Pre-procedure quality of life metrics were examined using KCCQ scores, Katz index, Lawton scale, STS score, and frailty score were included. The mean pre-procedure KCCQ score (n=50) was 29.16 (SD=11.919), Katz index (n=35) was 5.26 (SD= 1.094), Lawton scale (n=35) was 4.71 (SD= 2.573), STS score (n=51) was 12.28535 (SD= 5.638508), and frailty score (n=19) was 5.11 (SD= 1.100). Post-procedure metrics included 30-day KCCQ score, length of stay, discharge disposition, and 30-day readmission. The mean 30-day KCCQ score (n= 27) was 47.96 (SD=10.886). The median length of stay was five days. Thirty-three (64.7%) were discharged home, 13 (25.5%) went to a sub-acute rehabilitation facility, one (2%) went to the Veterans Affairs Medical Center (VAMC), three (5.9%) died, and one (2%) went to a long-term acute care (LTAC) facility. Seven patients (13.7%) were readmitted to a Norton facility within thirty days of being discharged from the hospital.

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