Tablets and Personal Health Monitoring Devices for Elderly TAVR Patients to Facilitate Improved Interdisciplinary Communication, Promote Patient and Caregiver Engagement, and Prevent Complications

Grant Application

Lisa Henry, DNP, CRNP of the UPMC Heart and Vascular Institute’s Center for Heart Valve Disease in partnership with Donna Roth, Carol Remaley, RN, Jen Bevan, RN, Liz Christiansen, CRNP, Joon Lee, MD, Thomas Gleason, MD, Forozan Navid, MD,John Schindler, MD

Proposed Innovation

Patients who undergo transcatheter aortic valve replacement (TAVR) are elderly adults with congestive heart failure and other chronic chronic medical problems, including hearing and vision problems. This can lead to poor communication and quality of life, increased healthcare costs from readmissions, and patient safety concerns.

The goal of this project was to use technology to improve communication and education to ensure patients make informed, comprehensive decisions regarding treatment options. It also was designed to empower and motivate patients by providing tools they could use to track their real time progress in conjunction with decision makers and UPMC TAVR team.

Improvements

Through this project, patients were shown educational videos on electronic tablets during consultation with the treatment team prior to the TAVR procedure. They also were offered a personal health monitoring device (Fitbit®) and scale (Fitbit Aria™) to track their activity, sleep, and weight for six months following the procedure. Data were stored on the UPMC website, where it could be viewed by patients, caregivers and providers. In addition, TAVR team members also monitored the data and contacted patients if they had any concerns, or to encourage and motivate them.

Outcomes

The TAVR Team reported mixed results from the project. Use of the tablets generated positive feedback by patients and family members as well as the clinical staff. It proved to be a very useful teaching tool, resulting in better informed patients who had the opportunity to ask questions or express concerns after watching the videos. As the TAVR procedure evolved, the tablets were updated to include newer iterations of transcatheter valves. Registered nurses also began using the tablets as a teaching tool once it was found to be useful to the patients and shared decision makers.

However, use of the Fitbit® and Fitbit Aria™ had little impact on hospital readmission rates, in part due to poor participation among the older patients, who found it overwhelming. In some cases, the technology was not compatible with pacemakers.

As a result, the TAVR team began offering the Fitbit® and Fitbit Aria™ scale technology to lower risk patients who are often younger and have more Internet access. Scales were also offered to patients with aortic stenosis at increased risk for heart failure who were ineligible for TAVR but were treated either with open heart surgery or medical management.