- ICH GCP
- Amerikanska kliniska prövningsregistret
- Klinisk prövning NCT02766075
A STEP for Patients Prior to Undergoing TAVR: A Pilot Study (STEP)
A Supervised TAVR Exercise Program (STEP) for Patients Prior to Undergoing Transcatheter Aortic Valve Replacement (TAVR): A Pilot Study
Studieöversikt
Status
Betingelser
Intervention / Behandling
Detaljerad beskrivning
TAVR is an approved alternative therapy for patients with severe aortic valve stenosis who are deemed inoperable or high-risk for surgical aortic valve replacement (SAVR). Despite a very high procedural success rate (>95%), mortality rates after TAVR at 1- and 2-year follow-up remain ≥25% and ≥34%, respectively. It is becoming increasingly evident that frailty, as a clinical syndrome, has a large impact on this long term mortality. In a study by Green, et al. frailty status was independently associated with increased 1-year mortality (OR=3.5) after TAVR. The investigators' own retrospective analysis showed that impaired mobility and malnutrition were significantly associated with a longer hospital length of stay (5 days vs. 3 days), and increased total cost (on average, an additional $10,000 per patient). Given the phenotype of frailty is characterized by reductions in muscle mass, strength, endurance and activity level, a STEP is ideally suited to counteract these impairments. This pilot study aims to establish whether a STEP can safely improve the frailty score in patients with symptomatic severe aortic valve stenosis prior to undergoing TAVR.
This single-center pilot study will be conducted in partnership between Heart Care Midwest (HCMW), OSF St. Francis Medical Center (OSF SFMC), and University of Illinois College of Medicine at Peoria (UICOMP). UICOMP Center of Outcomes Research will provide analytical support. The study will be funded by an operational research grant from OSF SFMC.
Studietyp
Inskrivning (Faktisk)
Fas
- Inte tillämpbar
Kontakter och platser
Studieorter
-
-
Illinois
-
Peoria, Illinois, Förenta staterna, 61630
- OSF St. Francis Medical Center
-
-
Deltagandekriterier
Urvalskriterier
Åldrar som är berättigade till studier
Tar emot friska volontärer
Kön som är behöriga för studier
Beskrivning
Inclusion Criteria:
- All adult patients scheduled to undergo first-time elective TAVR
Exclusion Criteria:
- Vulnerable populations including prisoners, pregnant females and patients less than 18 years age.
- Patients with history of unstable angina, myocardial infarction, or decompensated heart failure in the week prior to screening
- Patients with physical limitations (i.e. debilitating stroke, amputation, unable to complete initial screening frailty profile)
- Patients with advanced dementia or cognitive deficits (i.e. unable to follow instructions of initial screening frailty profile)
- Exercise-induced arrhythmias
Studieplan
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Stödjande vård
- Tilldelning: Randomiserad
- Interventionsmodell: Parallellt uppdrag
- Maskning: Enda
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
---|---|
Experimentell: Supervised TAVR Exercise Program (STEP)
Subjects in the experimental arm will participate in an individualized 4-week STEP prior to undergoing TAVR.
All subjects will undergo serial frailty assessments by a blinded research assistant at baseline, pre-TAVR, and 30-days post-TAVR.
|
Individualized exercise program designed and implemented by licensed physical therapy clinicians in three 60-minute sessions per week for four weeks.
Upon randomization, subjects in the Intervention Group will undergo an initial Dynamic Gait & Balance Assessment by a licensed physical therapy clinician.
The physical therapy clinician will use this assessment to design and implement an individualized STEP in three 60-minute sessions per week for four weeks.
Subjects will proceed with their pre-TAVR testing in conjunction with the STEP sessions.
|
Inget ingripande: Standard of Care
Subjects in the no intervention arm will proceed with their TAVR after a minimum 4 weeks without an exercise intervention.
All subjects will undergo serial frailty assessments by a blinded research assistant at baseline, pre-TAVR, and 30-days post-TAVR.
|
Vad mäter studien?
Primära resultatmått
Resultatmått |
Tidsram |
---|---|
Change in Frailty Score from Baseline to post-STEP
Tidsram: Baseline, 6-weeks
|
Baseline, 6-weeks
|
Sekundära resultatmått
Resultatmått |
Tidsram |
---|---|
Adverse Events
Tidsram: 6-weeks
|
6-weeks
|
Change in Frailty Score from Baseline to 30-days post-TAVR
Tidsram: Baseline, 30-days post-TAVR
|
Baseline, 30-days post-TAVR
|
Change in Gait Speed (5-Meter Walk Test) from Baseline to post-STEP
Tidsram: Baseline, 6-weeks
|
Baseline, 6-weeks
|
Change in Gait Speed (5-Meter Walk Test) from Baseline to 30-days post-TAVR
Tidsram: Baseline, 30-days post-TAVR
|
Baseline, 30-days post-TAVR
|
Change in Grip Strength (Dynamometer) from Baseline to post-STEP
Tidsram: Baseline, 6-weeks
|
Baseline, 6-weeks
|
Change in Grip Strength (Dynamometer) from Baseline to 30-days post-TAVR
Tidsram: Baseline, 30-days post-TAVR
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Baseline, 30-days post-TAVR
|
Change in Independent Activity (Katz Activities of Daily Living Survey) from Baseline to post-STEP
Tidsram: Baseline, 6-weeks
|
Baseline, 6-weeks
|
Change in Independent Activity (Katz Activities of Daily Living Survey) from Baseline to to 30-days post-TAVR
Tidsram: Baseline, 30-days post-TAVR
|
Baseline, 30-days post-TAVR
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Change in Malnutrition (Serum Albumin Level) from Baseline to 30-days post-TAVR
Tidsram: Baseline, 30-days post-TAVR
|
Baseline, 30-days post-TAVR
|
Samarbetspartners och utredare
Sponsor
Utredare
- Huvudutredare: Jay N Patel, MD, OSF HealthCare System
Studieavstämningsdatum
Studera stora datum
Studiestart (Faktisk)
Primärt slutförande (Faktisk)
Avslutad studie (Faktisk)
Studieregistreringsdatum
Först inskickad
Först inskickad som uppfyllde QC-kriterierna
Första postat (Uppskatta)
Uppdateringar av studier
Senaste uppdatering publicerad (Faktisk)
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
Senast verifierad
Mer information
Termer relaterade till denna studie
Ytterligare relevanta MeSH-villkor
Andra studie-ID-nummer
- 837484
Plan för individuella deltagardata (IPD)
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