{
  "abstract": "Introduction Transcatheter aortic valve implantation (TAVI) is a popular alternative to open heart surgery in the treatment of severe aortic valve stenosis for patients of advanced age and high frailty index. The increased TAVI service demand has created the need of dedicated, standardised and consistent patient follow-up.Objectives To improve adherence to the guideline recommended 3-monthly post-procedural review and assess the safety and impact of a dedicated advanced clinical practitioner (ACP) led follow-up clinic on post-TAVI care and wider cardiology services.Design Pareto technique and root cause analysis of a baseline TAVI follow-up service audit were used to compile a driver diagram and map scope for improvement. PDSA-cycle QI model was used to implement and assess proposed interventions. A fully qualified ACP with a pharmacist background autonomously reviewed consecutive randomly selected patients, face-to-face or virtually, in a once-weekly dedicated TAVI follow-up outpatient clinic over 5-month period using a pre-agreed service operating procedure. Patient and staff feedback was obtained using survey questionnaires. Clinical decisions were discussed with a consultant physician to assess the safety of this service concept. Baseline comparison data from an interventional cardiology consultant-led clinic was collected to evaluated indirect impact of an ACP-led TAVI follow-up on the wider outpatient services.Results A total of 94 consecutive patients were reviewed over 5 month period applying a pre-approved protocol. 90 patients (95.7%) had a video consultation and 4 (4.3%) had face-to-face appointment. On average 5 were reviewed per clinic with 16.04 minutes spent per patient. 1 patient did not attend. 45 patients (47.9%) were referred for first post-TAVI follow-up and 41 of those (91.2%) had their review and echocardiogram within 3 months of procedure. This was a 34.2% (p<0.01) improvement in TAVI guidelines adherence compared to baseline audit data. 49 patients (52%) were discharged, 39 patients (45.5%) were referred for further diagnostic tests and 2 patients (2%) were referred for coronary angiography. Post-TAVI complication rate was low with 1 patient diagnosed with valve thrombosis, 1 patient referred for an urgent pacemaker device and 2 patients monitored for persistent access site hematoma. No patient management changes were made following consultant oversight safety discussion. Positive service feedback was reported from both patients and staff. Compared to the preceding 5-months, average consultant-led cardiology clinic capacity increased by 27.5% (p<0.01) with a medial patient number shift from 20 to 14.5 per clinic session.Conclusion Our novel dedicated ACP-led post-TAVI follow-up clinic is a safe, effective and sustainable service model that can achieve a consistent, comprehensive and timely post-procedural patient review and improve the use of NHS staff resource while supporting a multidisciplinary care model.Abstract 514 Figure 1The indirect effect of the newly set-up ACP-led post-TAVI follow up clinic on the general cardiology consultant-led outpatient clinic patient load and capacity",
  "authors": [
    {
      "affiliations": [
        "Royal Brompton and Harefield Hospitals, part of Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Aleksandar Dimitrov"
    },
    {
      "affiliations": [
        "Royal Brompton and Harefield Hospitals, part of Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Nareen Dezayie"
    },
    {
      "affiliations": [
        "Royal Brompton and Harefield Hospitals, part of Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Athanasios Sakalidis"
    },
    {
      "affiliations": [
        "Royal Brompton and Harefield Hospitals, part of Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Anastasios Apostolos,Tito Kabir"
    },
    {
      "affiliations": [
        "Royal Brompton and Harefield Hospitals, part of Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Miles Dalby"
    },
    {
      "affiliations": [
        "Royal Brompton and Harefield Hospitals, part of Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Vasileios Panoulas"
    }
  ],
  "title": "514 TAVI follow-up service improvement –building a consistent, safe, efficient and sustainable multidisciplinary model of post-TAVI care",
  "uid": "f3ce5a88-29af-5ed7-940a-acead6b837ba"
}