Screening for And MAnaging Risk factors in TAVI: an Interdisciplinary Endeavor (SMARTIE)
Cardiovascular and Stroke Care
SMARTIE aims to establish a novel clinical care pathway involving a unique collaboration between Cardiology, Cardiac Surgery, Geriatric Psychiatry and Geriatric Medicine at Sunnybrook Health Sciences Centre for the screening and management of geriatric-specific risk factors such as cognitive impairment, neuropsychiatric symptoms and frailty in patients undergoing TAVI. Findings from this study will document previously unstudied risk factors for poorer outcomes in these patients and provide clinicians with valuable health status information of at-risk patients. It will also address a gap within the healthcare system with the development of a unique risk factor management strategy within Sunnybrook and the broader healthcare system to improve survival and quality of life in an at-risk patient population..
TAVI is a minimally invasive method of treating severe aortic stenosis in elderly, multi-morbid patients. Current clinical practice does not include screening for, and management of age-specific risk factors in TAVI, which may complicate recovery and significantly impact outcomes post-intervention. This study proposes to develop and implement a brief screening tool for geriatric-specific risk factors including cognitive impairment, depression and physical frailty in TAVI patients and establish a referral system in collaboration with specialists in Geriatric Psychiatry and Geriatric Medicine at Sunnybrook.
All patients referred to the TAVI clinic will be screened with the tool before and 6 months post-TAVI. Patients screening positive for risk factors will be referred appropriately. A comprehensive battery will be administered in consenting patients before and 6 months post-TAVI to validate the screening tool and characterize any changes in outcomes post TAVI. Differences in intervention outcomes including post-operative delirium, readmissions, mortality, and quality of life will also be recorded and compared between patients who screened positive, to those who screened negative for risk factors. To date, 127 new patients were screened at the TAVI clinic, of which one third (n=42) screened positive for cognitive impairment and/or depression, and 16 for physical frailty. Subsequently, 28 patients were referred to Geriatric Psychiatry and 8 to Medicine. 8 patients have completed the comprehensive battery.
The SMARTIE screen, if validated, is anticipated to improve patient care process by identification of at-risk patients requiring further care. It will also demonstrate that cognitive impairment, depression and frailty have important prognostic significance and are important potentially remediable risk factors in TAVI