Angela Chua

Second year advanced trainee in General Medicine, currently practicing at the Royal Adelaide Hospital.

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The Role Of An Internal Medicine Specialist Team In Supporting The Care Of Patients Contemplated For Transcatheter Aortic Valve Replacement

​Aims:
To evaluate the role of an internal medicine specialist team (IMST) in the management and decision process of a patient contemplating transcathether aortic valve replacement (TAVR).

Methods:
This is a retrospective quantitative review over a six-month period of patients with severe aortic stenosis not suitable for surgical aortic valve replacement referred by their Cardiologist for consideration of TAVR at a tertiary academic teaching hospital in South Australia. Patients referred to the TAVR clinic was reviewed by IMST and patient data was collected using the Allscripts Electronic Medical Records (EMR). The primary measurements recorded were functional status, body mass index (BMI) and co-morbidities. Screening for frailty, obstructive sleep apnoea (OSA), and dental health were included. Laboratory studies including haemoglobin, iron studies, renal function and albumin were collected. Interventions including iron infusions and other specialist or allied health referrals and multidisciplinary team (MDT) discussion outcome were recorded.

Results:
63 patients were reviewed by the IMST. The median age was 81 with 96.8% from home. 7% (4/58) were underweight, 44.8% (26/58) were overweight. 54% had more than three co-morbidities, mostly commonly hypertension (71.4%), CKD (52.3%) and diabetes (38%). Many had evidence of impairment in geriatric domains with 40% requiring mobility aids, over 50% requiring home supports and 30.2% screened positive for frailty. A total of 63 interventions for 41 patients including iron infusion and referrals to other specialist and allied health were made. Patients recommended for conservative management after the multidisciplinary heart team review tended to be older, with a lower BMI and higher number of co-morbidities.

Conclusions and/or Clinical Practice Point:
The IMST can provide interventions that improve the health of this population, as well as supporting complex decision making within the heart team. However, there is a lack of guidelines resulting in variability of screening and intervention. This opens up the possibility of a collaboration between cardiology and IMST to develop evidence-based guidelines to support the multidisciplinary heart team function and improve overall patient care.