Echo Waitlists can be Significantly Reduced by Determining Patients' Goals of Care (GOC) and Assessing Frailty Utilising a Nurse Led Clinic

Eddington, R.; Johnson, K.

Background: Elderly patients’ care pathways should reflect their goals. This requires patients to have an understanding of their overall health. Increased frailty diminishes the potential functional recovery after both transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). Increased echocardiogram waitlist during the COVID-19 pandemic highlighted the need to ensure patients were appropriate and would consider intervention. A pilot nurse clinic was undertaken to assess individualised risk using geriatric assessment tools, provide education and explore patients’ GOC. Method: Patients >75 years of age due for a planned valve surveillance echocardiogram were reviewed. Symptoms and important medical history were obtained. An Essential Frailty Test (EFT) was undertaken, with more detailed assessments where indicated. Principles from Serious Illness Conversation guided patient discussion, exploring patients’ understanding, goals and priorities for care. Patients discharged from echo surveillance were discussed with a cardiologist. Results: 29 patients were enrolled, with mean age, 78.59 ± 12 years. 10 continued echo surveillance, 15 elected withdrawal from surveillance as unlikely to consider intervention. This was due to overall health or GOC determined that they would rather discharge and reassess with GP if they became symptomatic, as quality of life was their focus, not mortality. 4 of these patients demonstrated new significant cognitive impairment. An additional 4 were discharged from surveillance due to prohibitive heath issues. All patients had individualised education, management plan, and referrals where required and were offered support with Advanced Care Planning. Conclusion: Empowering patient decision making with nurse led geriatric assessment, shared GOC discussion and patient education can significantly reduce echocardiography valve surveillance waitlists, while also improving patient focussed outcomes.