Telehealth Interventions for Cardiac Surgery (TICS)
Telehealth for Pre- and Post-Operative Monitoring of Cardiac Surgery Patients - A Randomised Controlled Trial
The goal of this clinical trial is to compare telehealth monitoring at home against usual care in patients undergoing planned heart surgery. The main questions it aims to answer are:
- Can telehealth improve quality of life prior to surgery
- Can telehealth prevent serious deterioration requiring hospital or primary care attendance
Participants awaiting heart surgery will be randomly allocated to either telehealth remote monitoring of symptoms, blood pressure, heart rate, oxygen levels and activity levels or they will be allocated to usual care which is unmonitored on the waiting list for surgery.
Researchers will compare telehealth to usual care to see if it improves quality of life or prevents deteriorations on the waiting list.
Study Overview
Status
Intervention / Treatment
Detailed Description
Patients on elective cardiac surgery waiting lists can deteriorate, presenting via acute services as urgent inpatients as a result of their decompensation and facing increased surgical risk. With increases in waiting times prevalent through the country, and healthcare resources under pressure from Covid-related backlogs, it is imperative to find ways to monitor and escalate the most vulnerable patients and to provide safe methods of providing healthcare interventions outside conventional hospital settings. Remote monitoring identifies patients at need, and allows tertiary-care led interventions to prevent deterioration in the first instance. Such facilities could also enhance recovery following treatment and reduce the risks of complications and readmissions post-operatively.
The benefits and risks of such programmes is, however, not well understood: additional monitoring may increase the burden of responsibility on patients or monitoring facilities without providing additional safeguards to the patient. The advantages of early detection may not translate into improved outcomes and the onus on the patient to report in may reduce quality of life rather than enhance it.
The researchers therefore seek to identify if telehealth monitoring can improve health related quality of life, reduce unplanned admissions and healthcare resource utilisation and enhance pre-habilitation using protocolised patient engagement facilities to reduce complications and improve risk-stratification metrics such as smoking status, diabetic control and BMI.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Mersey
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Liverpool, Mersey, United Kingdom, L14 3PE
- Liverpool Heart and Chest Hospital
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Adult patients over 18y referred and accepted for cardiac surgery
- Able to consent to participate
Exclusion Criteria:
- Urgent or emergent surgery
- Surgery planned within 3 weeks of first cardiac surgery outpatient review
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Experimental: Telehealth monitoring
Telehealth remote monitoring provided by a specialised service with a monitoring and patient education app featuring:
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Connected devices and smartphone apps to measure symptoms and observations at home, with centralisation of results to a staffed hub
Other Names:
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No Intervention: Standard of Care
Standard of care will be no remote monitoring for patients whilst on the waiting list or after discharge from hospital.
Access to tertiary services for advice, information or to report deteriorations will be through conventional existing modes such as printed or online literature provided at the time of outpatient review, telephone access to administrative staff allowing clinical information to be conveyed to the usual care team, and local primary care and emergency services for acute deteriorations.
Existing standard of care remote services (e.g.
wound monitoring by digital photograph reviews) will continue.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Change from baseline to admission in Healthcare related Quality of Life Change (EQ5D5L)
Time Frame: From baseline to admission for surgery (up to 52 weeks)
|
EQ5D5L will be measured by electronic questionnaire by the patient or a researcher on their behalf and indexed for representation on a scale from 0 (worst health, equivalent to being dead) - 1 (best health).
The difference in measures between baseline (randomisation) and admission for surgery (up to 52 weeks) will be measured.
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From baseline to admission for surgery (up to 52 weeks)
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Healthcare resource use during waiting list (composite counts of admission to hospital, A&E attendance and primary care appointment utilisation)
Time Frame: From baseline (randomisation) to admission for surgery (up to 52 weeks)
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Composite counts of admissions to hospital, Accident & Emergency hospital attendance, and primary care appointments for this health condition or complications of this health condition adjudicated by the research team.
The counts will be accrued from baseline (randomisation) to admission for surgery (up to 52 weeks).
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From baseline (randomisation) to admission for surgery (up to 52 weeks)
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Unplanned admissions pre- and post-surgery
Time Frame: From baseline to discharge from outpatient cardiac surgery service (up to 52 weeks)
|
Rates of unplanned admissions to hospital both pre- and post- surgery
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From baseline to discharge from outpatient cardiac surgery service (up to 52 weeks)
|
|
Diabetes control
Time Frame: From baseline (randomisation) to admission for surgery (up to 52 weeks)
|
Change from baseline to admission on HbA1c
|
From baseline (randomisation) to admission for surgery (up to 52 weeks)
|
|
Smoking cessation
Time Frame: From baseline (randomisation) to admission for surgery (up to 52 weeks)
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Change from baseline to admission on HbA1c
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From baseline (randomisation) to admission for surgery (up to 52 weeks)
|
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Post-operative Quality of Life Measures
Time Frame: From discharge from hospital admission to discharge from outpatient cardiac surgery service (up to 52 weeks)
|
Healthcare related Quality of Life Change (EQ5D5L change) as an indexed measure from 0 (worst health, equivalent to being dead) to 1 (best health).
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From discharge from hospital admission to discharge from outpatient cardiac surgery service (up to 52 weeks)
|
|
Change in post-operative complications
Time Frame: From discharge from hospital admission to discharge from outpatient cardiac surgery service (up to 52 weeks)
|
Rates of post-operative complications including mortality, stroke, lower respiratory tract infections, surgical site infections
|
From discharge from hospital admission to discharge from outpatient cardiac surgery service (up to 52 weeks)
|
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Length of hospital stay
Time Frame: From admission for surgery to discharge from hospital (up to 52 weeks)
|
Total in-hospital stay
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From admission for surgery to discharge from hospital (up to 52 weeks)
|
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Ventilator Time
Time Frame: From admission for surgery to discharge from hospital (up to 52 weeks)
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Total cumulative time with invasive ventilation following index procedure
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From admission for surgery to discharge from hospital (up to 52 weeks)
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Length of intensive care stay
Time Frame: From admission for surgery to discharge from hospital (up to 52 weeks)
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Total critical care stay for index admission
|
From admission for surgery to discharge from hospital (up to 52 weeks)
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Weight loss
Time Frame: From baseline (randomisation) to admission for surgery (up to 52 weeks)
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Change in body mass index on waiting list
|
From baseline (randomisation) to admission for surgery (up to 52 weeks)
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Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- TICS
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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