Can a home video program help frail older adults recover after heart valve surgery?

The TELE FRAIL clinical trial is a randomized trial designed to compare, among older frail patients with aortic stenosis undergoing transcatheter valve intervention (TAVI), the impact of usual care after vs a telematic intervention (including a supervised exercise training program, nutrition and education) on frailty reversal and clinical outcomes three months after the TAVI procedure.

The trial will include older patients a with baseline frailty criteria with severe AS undergoing TAVI. A comprehensive geriatric assessment will be performed after the TAVI procedure in all patients.

Inclusion criteria will be: a) patients aged 75 years or older; b) severe symptomatic aortic stenosis, as defined by a mean aortic gradient≥40 mmHg and/or an aortic valve area \< 1cm2 measured by transtoracic echocardiography; c) performance of successful TAVI during the admission, and d) baseline frailty criteria, as defined by Short Physical Performance Battery test value \<10 and a FRAIL scale value ≥3.

Exclusion criteria will be: a) negative to participate in the trial; b) unability to undergo a comprehensive geriatric assessment or study related procedures ; c) unability to complete clinical follow up, and d) life expectancy lower than one year.

Patients will be randomized (1:1) to intervention or control arms before hospital discharge after the TAVI procedure.

Patients assigned to the intervention will undergo a telematic intervention during the first 90 days after the admission. Trained nurses form an specialized company will contact patients by videocalls at weeks 1,3,5,7,9,11 an12 months. This telematic intervention will include 1) a supervised exercise program (based on an adaptation of the VIVI-FRAIL program) during this 12 weeks; 2) nutrition intervention: The investigator team will provide patients with nutrition supplements for the first 12 weeks after the admission. Patients will take daily a dose of 200 ml of hypercaloric hyperproteic supplements one hour after performing the corresponding exercise training session. Patients will also receive information about the optimal dieta adapted to their clinical profile; and c) health education about the disease, the importance of adherence to medical treatments and recommendations and the best measures for preventing complications.

Main outcome measured will be the proportion of patients with frailty (as measured by a Short Physical Performance Battery test value \<10) 3 months after the admission.

Secondary outcomes will include 1) the number of days alive out of hospital during the first year, 2) need for readmission at 3 months and at one year, 3) overall mortality at one year, 4) incidence of cardiovascular events (myocardial infarction, need for unplanned revascularization or stroke) at 3 months and at one year, 5) proportion of frail patients (SPPB\<10) at one year, 6)disability for acitivies of daily living (Barthel index) at three months and at one year, 7) nutritional risk (as measured by the MA-Sf test) at three months and at one year and 8) quality of life (as defined by the EQ-5D-5L test) at three months and at one year.