- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03690492
The Box 2.0: Using Smart Technology for Early Diagnosis of Complications After Cardiovascular Surgery
Study Overview
Status
Intervention / Treatment
Detailed Description
Over the past five years, smartphone compatible detectors of cardiovascular disease parameters have been released on the consumers market. Examples of these include heart rate monitors, ECG monitors, blood pressure monitors, activity trackers and fat percentages monitors. These monitors have often been validated and are CE-marked for use in the European Union within their intended use.
Recent publications implicate that home monitoring with such consumer devices might improve quality of care. A study by Bosworth et al. in patients with hypertension showed that increased monitoring and subsequent treatment led to a better controlled blood pressure in patients who were treated for hypertension. Another study, which is currently being carried out at the LUMC, is investigating whether patients benefit from a smart technology intervention after they had a myocardial infarction. Preliminary (unpublished) results show that clinical outcomes are similar, with higher patient satisfaction. Cost analyses show that there is a cost reduction per patient with smart technology follow-up. Therefore, smart technology could be a useful tool to improve patient monitoring and therefore patient safety.
Patients who are discharged after they underwent cardiovascular surgery are at risk to develop one or more of three most seen late complications: sternal wound infection, cardiac decompensation or rhythm disturbances such as atrial fibrillation. This is not always detected before those patients are discharged.
Currently, patients who underwent cardiovascular surgery return to the outpatient clinic 14 days and three months after discharge. They are seen by a specialist nurse or cardiologist, who will perform a general check-up and inspect the sternal wound. An echocardiogram will be performed before the three-month visit. If there is suspicion for a rhythm disturbance on the outpatient clinic visit, the cardiologist might decide to perform Holter monitoring during 24 hours. As this is a small window of time, not all rhythm disturbances will be diagnosed. Smart technology is hypothesized to increase the chances of diagnosing rhythm disturbances. In the case of sternal wound infection and cardiac decompensation, smart technology may show a declining trend before a patient visits the outpatient clinic, which can lead to early detection and treatment.
A small pilot study by McElroy et all found that after cardiovascular surgery, both the patient as well as the health care team are highly satisfied with added smart technology, due to the ease of use of the technology and platform. There was a main focus on readmission rates, which did not differ between the groups. However the trend shows an increase in diagnosing atrial fibrillation (15,4 vs 29,6%), sternal wound infection or cardiac decompensation were not studied.
To our knowledge, no other study has yet looked into diagnosing late complications after cardiovascular surgery with the help of smart technology. It is hypothesized that smart technology could help diagnose the main three diagnoses mentioned above early on and with that, improve quality of care in patients after cardiovascular surgery. Therefore, in this study, the clinical effectiveness of a smart technology intervention is investigated in patients who have underwent cardiovascular surgery at the department of Thoracic Surgery at Leiden University Medical Center.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Zuid Holland
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Leiden, Zuid Holland, Netherlands, 2333 ZA
- Leiden University Medical Centre
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patient undergoes cardiovascular surgery: CABG, valve reconstruction or replacement, aortic root or ascending aortic surgery, or any other cardiothoracic surgery performed by median sternotomy such as atrial or ventricular septal defect closure, Dor or Morrow procedure, cardiac tumor removal and/or surgical treatment of coronary artery anomalies.
- Patient is able to communicate in English or Dutch
- Patient has been referred by a cardiologist from the Leiden University Medical Center, Cardiological Center Voorschoten, Alrijne Hospital or Haaglanden Medical Center
Exclusion Criteria:
- Patient is < 18 years old
- Patient is pregnant
- Patient is considered an incapacitated adult
- Patient is unwilling to sign the informed consent form
- Patient undergoes emergency thoracic surgery (INTERMACS 1 or 2)
- Patient has active endocarditis at the time of operation
- Patient is on mechanical circulatory support before operation
- Patient has a ventricular septal rupture
- Patient undergoes extracorporeal membrane oxygenation or ventricular assist device insertion
Study Plan
How is the study designed?
Design Details
- Primary Purpose: DIAGNOSTIC
- Allocation: NON_RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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EXPERIMENTAL: The Box 2.0
Patients will be given a Box, in which they will find a thermometer, blood pressure monitor, activity tracker, weight scale, blood oxygen saturation monitor, a single lead ECG device and a four lead ECG device.
Also, they will be followed-up by use of two webcam consultations instead of a normal outpatient clinic visit.
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Patients in the intervention arm will receive a Box with several devices that is hypothesized to allow for better and earlier detection of complications after cardiac surgery.
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NO_INTERVENTION: Controls
Patients will not receive a Box.
They will be followed up by standard care, returning to the outpatient clinic at the same frequency and timing as The Box 2.0 arm.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Dectection of and time to detection of atrial fibrillation
Time Frame: Until 3 months after surgery
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Diagnosis of atrial fibrillation and the time it took a subject to reach that outcome, measured in both study arms
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Until 3 months after surgery
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Dectection of and time to detection of cardiac decompensation
Time Frame: Until 3 months after surgery
|
Diagnosis of cardiac decompensation and the time it took a subject to reach that outcome, measured in both study arms
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Until 3 months after surgery
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Quality of Life (QoL)
Time Frame: 3 months after surgery
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QoL of both study arms, using the EQ-5D-5L (Dutch translation)
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3 months after surgery
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Patient satisfaction of care
Time Frame: 3 months after surgery
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Satisfaction in both study arms, using a modified PSQ-18 (Dutch translation)
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3 months after surgery
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Overall mortality
Time Frame: 3 months after surgery
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Mortality in both study arms
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3 months after surgery
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Major adverse cardiac events
Time Frame: Until 3 months after surgery
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Either cardiac death, myocardial infarction, cardiac tamponade, TIA or ischaemic stroke
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Until 3 months after surgery
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Re-admission to either the cardiology or thoracic surgery ward
Time Frame: Until 3 months after surgery
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Re-admission in both study arms
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Until 3 months after surgery
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Total amount of cardiology related visits to an emergency department until three months after discharge
Time Frame: Until 3 months after surgery
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ER visits (at the Leids University Medical Center, Alrijne Ziekenhuis or Haaglanden Medisch Centrum) in both arms
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Until 3 months after surgery
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Blood pressure control
Time Frame: 3 months after surgery
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BP control in both study arms, both systolic and diastolic
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3 months after surgery
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Cost-effectiveness
Time Frame: 2 years
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Cost-effectiveness of the intervention
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2 years
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Detection of and time to detection of sternal wound infection
Time Frame: Until 3 months after surgery
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Diagnosis of sternal wound infection and the time it took a subject to reach that outcome, measured in both study arms
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Until 3 months after surgery
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Collaborators and Investigators
Sponsor
Publications and helpful links
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- NL65959.058.18
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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