Clinical effectiveness of an information platform–enabled multidisciplinary Enhanced Recovery After Surgery (ERAS) programme for patients undergoing transcatheter aortic valve replacement (TAVR)

Clinical effectiveness of an information platform–enabled multidisciplinary Enhanced Recovery After Surgery (ERAS) programme for patients undergoing transcatheter aortic valve replacement (TAVR) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical effectiveness of an information platform–enabled multidisciplinary Enhanced Recovery After Surgery (ERAS) programme for patients undergoing transcatheter aortic valve replacement (TAVR) Shaoping Lin, Meizhen Guan, Jiaxin Li, Lian Lin, Jiezhen Liu, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7514382/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Objective To evaluate, using a digital health–enabled approach, whether a multidisciplinary enhanced recovery team improves peri-hospital and post-discharge recovery among patients undergoing transcatheter aortic valve implantation (TAVI). Methods We conducted a non-contemporaneous controlled (before–after) study. Patients who underwent TAVI between 2023 and August 2024 and received routine care formed the control group. From September 2024 onward, patients undergoing TAVI received routine care augmented by a multidisciplinary enhanced recovery after surgery team (ERAS-MDT) delivered via an information platform, spanning inpatient care through home-based follow-up (intervention group). Outcomes included ERAS knowledge, early frailty, activity/functional capacity, length of stay (LOS), and longer-term quality of life assessed by the 12-Item Short-Form Health Survey (SF-12), 6-minute walk test (6MWT), and echocardiographic left ventricular ejection fraction (LVEF). Group differences were compared using appropriate parametric or non-parametric tests with two-sided significance set at P < 0.05. Results Baseline characteristics (age, sex, education, and comorbid conditions) did not differ significantly between groups. Relative to controls, the intervention group demonstrated higher ERAS knowledge scores [26.50 (23.00–29.00) vs 34.00 (32.00–35.00), P < 0.01], a lower prevalence of early frailty [34 (44.74%) vs 18 (23.07%), P < 0.01], better activity/functional capacity (57.24 ± 18.68 vs 65.20 ± 18.87, P < 0.01), and shorter LOS [20.00 (15.00–24.25) vs 14.00 (11.00–17.00) days, P < 0.01]. Longer-term outcomes also favored the intervention group: SF-12 summary scores [93.00 (90.00–98.25) vs 98.00 (93.70–10.00), P < 0.01], 6MWT distance [320.00 (224.00–351.00) vs 338.00 (306.75–360.00) m, P < 0.01], and LVEF [65.00 (60.00–68.00) vs 69.50 (66.00–70.00) %, P < 0.01] indicated greater improvement compared with controls. Conclusions Embedding a digital information platform within an ERAS-MDT pathway for TAVI aligns with patients’ needs for continuous, end-to-end recovery support and is associated with superior knowledge acquisition, reduced early frailty, enhanced functional status, shorter hospitalization, and improved longer-term quality of life. Transcatheter aortic valve implantation Severe aortic stenosis Enhanced recovery after surgery Multidisciplinary collaboration Digital health platform Figures Figure 1 Introduction Since its introduction, transcatheter aortic valve implantation (TAVI) has been offered primarily to older adults with severe aortic stenosis who carry multiple high-risk factors for open surgery; however, as an interventional modality it remains associated with delayed recovery of self-care, prolonged hospitalization, and suboptimal long-term quality of life [ 1 – 3 ]. Among these elderly, multimorbid patients, the post-discharge phase is characterized by a protracted rehabilitation course [ 4 ], a continuing need for scheduled reassessment and long-term follow-up, and heightened concerns regarding the safety of healthcare activities [ 5 ]. In line with contemporary care imperatives, there is a need to devise rehabilitation pathways that mitigate risk through specialized, individualized interventions for high-risk populations and that can be seamlessly extended into the home setting after discharge. Accordingly, beginning in September 2022, we convened a multidisciplinary team (MDT) and deployed a WeChat-based digital platform to integrate a suite of discipline-specific rehabilitation measures, advancing an outcome-evaluation–driven, full-course enhanced recovery after surgery (ERAS) model for patients undergoing TAVI [ 6 – 7 ]. This approach reduced postoperative stress responses and complications and accelerated recovery, yielding favorable clinical effects. Materials and Methods 2.1 Inclusion and exclusion criteria Inclusion criteria: (i) candidates meeting indications for transcatheter aortic valve replacement (TAVR; also termed TAVI); (ii) able to use a smartphone independently with adequate reading and comprehension; (iii) procedure performed during the index hospitalization; (iv) intact consciousness with effective communication. Exclusion criteria: (i) critically ill patients or those with cerebrovascular disease or other malignancies; (ii) severe cognitive impairment, psychiatric disorders, or speech/language disorders limiting communication; (iii) inability to complete ≥12 months of follow-up. 2.2 Study population We adopted a non-contemporaneous (before–after) controlled design. Patients undergoing TAVR from 2020 to August 2023 (n=76) received routine care and comprised the control group. From September 2023 onward, patients (n=78) received routine care plus an information-platform–enabled enhanced recovery programme (intervention group). The study was approved by the institutional ethics committee, and all participants provided written informed consent. 2.3 Study procedures 2.3.1 Control group Before surgery, patients attended a standard group briefing in which nurses provided verbal education on the procedure and preoperative preparation. Postoperatively, patients followed medical orders to avoid unnecessary tubing and to remove drains/catheters as early as appropriate; early ambulation was encouraged. Nurses explained the importance of rehabilitation exercises and adherence to a nutritional plan, and demonstrated deep-breathing and effective coughing. After discharge, patients were instructed to attend scheduled clinic visits and to participate in outpatient cardiac rehabilitation. 2.3.2 Intervention group 2.3.2.1 Information-platform ERAS–MDT structure A multidisciplinary team (MDT) supported an information-platform–enabled ERAS pathway: physicians held overall responsibility for procedural planning and longitudinal oversight; the ward head nurse supervised and coordinated MDT operations; six rehabilitation therapists assessed exercise capacity and nutritional status and designed/provided comprehensive cardiopulmonary rehabilitation across the care continuum; and a six-member nursing team maintained and updated platform content, motivated and coached patients to implement ERAS effectively, and assisted with rehabilitation evaluation and feedback. 2.3.2.2 Specific implementation of the information-platform ERAS programme Leveraging the WeChat ecosystem, an A5 QR code poster was placed at each bedside and on the ward education board to operationalise a four-stage intervention spanning admission, surgery preparation, postoperative care, and home-based continued rehabilitation. (i) Admission-phase intervention. Upon ward entry, and after obtaining consent, nurses guided patients to scan the QR code and follow the official WeChat account. The system automatically pushed admission instructions and a user guide to the platform, enabling initial familiarization with a contact-free mode of knowledge delivery. (ii) Preoperative intervention. The ERAS–MDT performed individualized assessments of exercise capacity and nutritional status and provided guidance on pain self-assessment. Based on the rehabilitation plan devised by therapists, nurses used the WeChat account to deliver tailored education through multimodal materials (text-and-image posts, videos, animations, and comics). The team first introduced the overall pathway and pushed an animated illustration of the surgical procedure to enhance understanding of the treatment plan. Self-care lessons and nutrition/exercise plans were then scheduled as daily pushes aligned with clinical steps. Detailed videos demonstrated specific rehabilitation movements—such as cardiopulmonary/respiratory-muscle training, supine ankle-pump exercises, bedside standing drills, and 6-minute walk practice—and post-reading questionnaires were used to ascertain patient needs. Education was contact-free and reiterative; nurses assessed preoperative learning and mastery before surgery. (iii) Postoperative intervention. Rehabilitation therapists evaluated patients daily. The information-platform ERAS–MDT continuously reviewed each patient’s status to facilitate early removal of tubes, perform targeted pain assessments with analgesia adjustments, restore nutritional parameters promptly, and initiate early in-bed limb activity and assisted ambulation. The platform disseminated success stories and interactive talks to bolster confidence and motivation and to reinforce adherence to early functional training. When repetition was needed, patients could consult the account’s “History” archive to review prior content at any time. Therapists adjusted programme content and intensity in real time, while nurses evaluated learning and execution against the individualized WeChat rehabilitation plan and provided ongoing assessment and feedback. (iv) Home-based intervention. Using the platform’s rehabilitation check-in and online class-booking features, patients were encouraged to schedule group sessions after discharge and to participate in home exercises via live video, thereby supporting adherence to ERAS and enabling continuous outcome evaluation. For questions arising at home, patients could leave messages or enter keywords to receive bundled, continuously updated topic materials, facilitating long-term learning and dissemination of rehabilitation knowledge to patients and family members. The intervention arm was advanced in an outcome-evaluation-driven manner, with the MDT overseeing progress and adapting the plan in a timely fashion (Figure 1). 2.4 Outcome measures 2.4.1 Knowledge of TAVI under ERAS. A self-developed questionnaire was used to assess patients’ knowledge of TAVI within the ERAS pathway in both groups. The instrument comprises 37 items across four dimensions; higher scores denote better knowledge. Internal consistency was high (Cronbach’s α=0.905), with a validity coefficient of 0.929. 2.4.2 Early frailty and functional capacity. Frailty was evaluated using the Fried frailty phenotype across five dimensions, categorising scores ≥3 as frail (frailty syndrome), 1–2 as pre-frail, and 0 as robust. Functional capacity was assessed with the Barthel Index (BI), where higher scores indicate greater independence in activities of daily living. 2.4.3 Length of stay. Length-of-stay outcomes included intensive care unit stay, postoperative ward stay, and total hospital stay. 2.4.4 Long-term quality of life. Subjective quality of life was measured using the 12-Item Short Form Health Survey (SF-12), covering six domains—general health, physical functioning, vitality, bodily pain, mental health, and social functioning—with higher scores indicating better status. Objective cardiac function was evaluated by the 6-minute walk test (6MWT) obtained postoperatively for comparison, and by transthoracic echocardiography at 1, 3, 6, and 12 months after discharge, focusing on left ventricular ejection fraction (LVEF). Higher overall scores reflected better long-term quality of life [8-9]. 2.5 Statistical analysis Analyses were conducted using SPSS 26.0. For continuous variables, normality was assessed with the Kolmogorov–Smirnov test. Normally distributed data are presented as mean±SD and compared using independent-samples t tests. Non-normally distributed data are expressed as median (Q1, Q3) and compared with the Wilcoxon rank-sum test. Categorical variables are summarised as n (%) and compared using the χ² test. Two-tailed P<0.01 was considered statistically significant. Results 3.1 Comparison of baseline characteristics between groups Sex, age, educational attainment, number of baseline comorbidities, and Mini-Mental State Examination (MMSE) scores did not differ significantly between groups (all P > 0.01; Table 1 ), indicating good comparability. Table 1 Baseline characteristics of the control and intervention groups group Sex, n (%) Age, years, mean ± SD Education level, n (%) Baseline comorbidities Male Female Primary school or below Junior middle school Senior high school/technical secondary Junior college or above Baseline comorbidities ≥ 3, n (%) MMSE, median (Q1, Q3) Control (n = 76) 22(28.95) 54(71.05) 73.37 ± 6.86 18(23.68) 26(34.21) 21(27.63) 11(14.47) 72(94.74) 23.00(19.75,26.00) Intervention (n = 78) 33(42.31) 45(57.69) 73.35 ± 7.06 27(34.62) 23(29.49) 17(21.79) 11(14.10) 70(89.74) 22.00(21.00,24.00) χ²/t/Z 2.993 0.020 2.379 1.336 0.953 P value 0.084 0.984 0.498 0.248 0.341 3.2 Comparison of awareness of infection-prevention and TAVI-within-ERAS knowledge between groups Before the intervention, scores were uniformly low in both groups and did not differ significantly (P > 0.01). After the intervention, the intervention group achieved higher scores than the control group across all three subdomains—TAVI knowledge, ERAS-oriented nutritional management, and ERAS functional training—with statistically significant between-group differences (P < 0.01; Table 2 ). Table 2 Comparison of awareness of infection-prevention and TAVI health-education content Evaluation index Control (n = 76) Intervention (n = 78) Z1 P1 Z2 P2 Pre-intervention Post-intervention Pre-intervention Post-intervention TAVI knowledge 5.00(4.00,7.00) 7.00(6.00,8.00) 6.00(5.00,7.25) 10.00(9.00,10.00) 1.594 0.111 6.716 < 0.001 ERAS nutritional management 4.00(1.00,6.00) 8.00(6.00,9.00) 5.00(2.00,7.00) 10.00(9.00,10.00) 1.819 0.069 5.494 < 0.001 ERAS functional training 5.00(4.00,6.00) 6.00(5.00,8.00) 5.00(4.00,6.00) 9.00(8.00,9.00) 0.003 0.997 6.925 < 0.001 Note: Data are median (Q1, Q3). Z1 and P1 denote between-group comparisons before intervention; Z2 and P2 denote between-group comparisons after intervention. Two-tailed significance threshold P < 0.01 as prespecified. 3.3 Comparison of early frailty and functional capacity between groups Postoperative frailty assessments showed a lower proportion of patients meeting criteria for the frailty syndrome in the intervention group than in controls. Postoperative activity scores were significantly higher in the intervention group than in the control group. All differences were statistically significant (P < 0.01; Table 3 ). Table 3 Postoperative frailty status and activity capacity Postoperative metric Control (n = 76) Intervention (n = 78) χ²/t P value Fried frailty phenotype, n (%) 27.755 < 0.001 Robust 1(1.32) 5(6.41) Pre-frail 41(53.94) 55(70.52) Frailty syndrome 34(44.74) 18(23.07) Barthel Index, mean ± SD (points) 57.24 ± 18.68 65.20 ± 18.87 -2.752 0.007 3.4 Comparison of ICU and hospitalization durations between groups The intervention group showed significantly shorter intensive care unit (ICU) stay, postoperative ward stay, and total length of hospitalization than the control group (all P < 0.01; Table 4 ). Table 4 Lengths of ICU stay and hospitalization Postoperative metric Control (n = 76) Intervention (n = 78) Z P value ICU stay, days 5.00(4.00,7.00) 3.50(2.00,5.00) 3.689 < 0.001 Postoperative ward stay, days 11.00(9.00,16.00) 8.00(6.00,9.25) 4.949 < 0.001 Total hospital stay, days 20.00(15.00,24.25) 14.00(11.00,17.00) 4.466 < 0.001 3.5 Comparison of long-term quality of life between groups Based on the 12-Item Short Form Health Survey (SF-12) and the objective 6-minute walk test (6MWT), both groups exhibited uniformly low scores before the intervention, reflecting mid-to-low quality-of-life levels, with no significant between-group differences (P > 0.01). After the intervention, scores improved significantly and the intervention group outperformed the control group, with statistically significant between-group differences (P 0.01). Post-intervention, EF% improved more markedly in the intervention group, and the between-group separation increased over time; all postoperative comparisons were statistically significant (P < 0.01; Table 6 ). Table 5 Comparison of SF-12 and 6-minute walk test between groups Measure Control (n = 76) Intervention (n = 78) Z1 P1 Z2 P2 Pre-intervention Post-intervention Pre-intervention Post-intervention SF-12 score 88.00(84.00,92.000) 93.00(90.00,98.25) 87.00(83.75,90.00) 98.00(93.70,10.00) 0.227 0.820 4.058 < 0.001 6MWT distance (m) 311.00(195.50,333.25) 320.00(224.00,351.00) 286.00(210.00,324.75) 346.00(318.50,368.75) 0.361 0.718 2.320 0.005 Note: Data are median (Q1, Q3). Z1 and P1 denote between-group comparisons before intervention; Z2 and P2 denote between-group comparisons after intervention. Two-tailed significance threshold P < 0.01 as prespecified. Table 6 Comparison of echocardiographic left ventricular ejection fraction (EF%) between groups Time point Control (n = 76) Intervention (n = 78) Z P value Preoperative EF% 45.00(33.00,55.00) 44.00(40.75,55.00) 1.390 0.164 Perioperative postoperative EF% 56.00(44.00,63.00) 60.00(52.00,66.00) 2.602 0.009 1 month post-op EF% 58.50(44.00,65.00) 63.00(60.00,68.00) 3.580 < 0.001 3 months post-op EF% 60.00(54.25,65.00) 66.00(60.00,70.00) 3.088 0.002 6 months post-op EF% 60.00(54.00,66.00) 68.00(61.50,70.00) 4.406 < 0.001 12 months post-op EF% 65.00(60.00,68.00) 69.50(66.00,70.00) 4.822 < 0.001 Note:Data are median (Q1, Q3). Two-tailed significance threshold P < 0.01 as prespecified. Discussion 4.1 Information-enabled ERAS improves disease knowledge and adherence in patients undergoing TAVI Health education is the primary pillar of the information-enabled ERAS pathway [ 10 ]. Using a digital platform for admission guidance and early preoperative education—rather than traditional didactic lectures or mass briefings—reduces crowding and contact, thereby lowering the risk of cross-infection. In contrast to one-way, monotonous delivery via verbal instruction or leaflets, the platform standardises the instructional pathway; content is no longer limited by variability in nurses’ knowledge, communication skills, or available time, ensuring implementation that is both homogeneous and tailored to each patient. Education for patients and family members is freed from temporal and spatial constraints, allowing flexible, distributed learning. For rehabilitation plans that are not easily mastered at first, videos and animations that deconstruct movements increase engagement, facilitate imitation learning, and help address both infection-control requirements and suboptimal comprehension. Older, multimorbid patients undergoing TAVI frequently experience anxiety [ 11 ]; the platform’s capacity for repeated viewing and unrestricted sharing with relatives and friends strengthens family and social support [ 12 ], reduces psychological burden, and enhances adherence. 4.2 Information-enabled ERAS enhances early postoperative mobility after TAVI Driven by outcome evaluation, the information-enabled ERAS pathway allows real-time titration to individual pace and variability, strengthening nutrition and functional capacity within patients’ tolerance thresholds. This approach advances earlier and higher-quality ambulation and exercise, and lowers the incidence of postoperative frailty events in older patients, consistent with the findings of Liu Feifan [ 13 ]. The MDT periodically releases assessment results; patients receive bundled, continuously updated content on the platform, enabling timely refresh of ERAS learning, reducing redundancy at the same rehabilitation stage, and reinforcing confidence. When patients are intolerant or lack support and motivation during the early ICU phase, the platform pushes “check-in” posts and success-case modules to elicit peer-modeling and vicarious motivation [ 14 ], thereby promoting active engagement with early-phase protocols. 4.3 Information-enabled ERAS shortens hospitalization and mitigates infection risk after TAVI By accelerating postoperative recovery, the pathway promotes early removal of tubes/drains and early ambulation to reduce complications [ 15 ], thereby expediting the return to self-care and shortening both ICU and total hospital length of stay. These benefits not only decrease hospitalization costs and facilitate earlier reintegration into family and society, but also lessen the risk of cross-infection during epidemic periods and reduce the likelihood of other hospital-acquired infections, in line with findings from rehabilitation research [ 16 ]. Moreover, the digital platform provides a convenient conduit for patient–clinician communication, easing concerns about continuity of ERAS follow-up and strengthening confidence in home-based care after discharge. 4.4 Information-enabled ERAS improves long-term quality of life after TAVI At present, some clinical departments rely on ad-hoc WeChat groups and manual guidance to deliver rehabilitation and continuity of care [ 17 ]. Such approaches are prone to information loss, remain labour-intensive, and show limited standardisation [ 18 ], making it difficult to support synchronous, remote exercise with continuous, transparent supervision and analytics. In our programme, an online class-booking function sustains engagement with the longitudinal ERAS plan, while the continuous release of image-and-text check-ins enables both clinicians and patients to track implementation and adherence in real time [ 19 – 20 ]. Coupled with online consultations and scheduled reassessment of cardiac indices, home self-care can be monitored and adjusted, thereby further improving outcomes. Notably, during periods of home quarantine or epidemic control, ERAS activities can proceed without spatial or temporal constraints, reducing the costs of maintaining rehabilitation and preventing programme interruptions due to lockdowns or on-site capacity limits. In our one-year follow-up, the information-enabled ERAS pathway was associated with progressively greater improvements in left ventricular ejection fraction and cardiopulmonary performance over time, facilitating efficient, precise clinician–patient communication and guidance, with durable benefits for both parties and enhanced long-term quality of life. Summary Successful TAVI is not the end of treatment. Implementing a long-term ERAS pathway via a digital platform is pragmatically valuable: it addresses gaps across multiple care nodes, conserves hospital resources, strengthens multidisciplinary teamwork, accelerates recovery, and provides a scalable reference for diversified, individualised models of continuity of care. Declarations Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was granted by the Ethics Committee of Jinshazhou Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China (Approval No.: [JZSH-EC-2023-278]. Written informed consent was obtained from all participants prior to data collection. Consent for publication Not applicable. The manuscript does not contain any individual person’s data (images, videos, or other identifying details) requiring consent for publication. Availability of data and materials De-identified data underlying the findings of this study are available from the corresponding author upon reasonable request, subject to institutional data-sharing policies and patient privacy considerations. Template wording conforms to journal guidance on data availability statements. Competing interests The authors declare that they have no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors’ contributions SL (Shaoping Lin): Conceptualization; Methodology; Investigation; Writing—original draft. MG (Meizhen Guan): Data curation; Formal analysis; Visualization; Writing—review & editing. JL (Jiaxin Li): Investigation; Project administration; Resources. LL (Lian Lin): Supervision (nursing operations); Methodology; Validation. JZL (Jiezhen Liu): Echocardiographic data acquisition; Formal analysis; Interpretation. FC (Cuicui Feng): Rehabilitation protocol development; Patient education content; Visualization. FFL (Fangfang Lin): Overall supervision; Funding/administrative support; Writing—review & editing; Final approval of the version to be published. All authors read and approved the final manuscript. Acknowledgements Not applicable. References Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal . 2021;42(36):407–473. doi:10.1093/eurheartj/ehab395. Damluji AA, Diaz-Castrillon CE, Forman DE, et al. TAVR in Older Adults: Moving Toward a Comprehensive Patient-Centered Care Paradigm. JACC: Advances . 2024;3:100877. doi:10.1016/j.jacadv.2024.100877. Holierook M, Henstra MJ, Dolman DJ, et al. Higher Edmonton Frail Scale prior to transcatheter Aortic Valve Implantation is related to longer hospital stay and mortality. International Journal of Cardiology . 2024;399:131637. doi:10.1016/j.ijcard.2023.131637. Zou J, Deng Y, Zhu L, et al. Impact of cardiac rehabilitation on pre- and post-operative transcatheter aortic valve replacement prognoses. Frontiers in Cardiovascular Medicine . 2023;10:1164104. doi:10.3389/fcvm.2023.1164104. Strange JE, Holt A, Christensen DM, et al. Frailty and Recurrent Hospitalization After Transcatheter Aortic Valve Replacement. Journal of the American Heart Association . 2023;12(8):e029264. doi:10.1161/JAHA.122.029264. Grant MC, Crisafi C, Alvarez A, et al. Perioperative Care in Cardiac Surgery: A Joint Consensus Statement by the ERAS Cardiac Society, ERAS Society, and The Society of Thoracic Surgeons (STS). Annals of Thoracic Surgery . 2024;117(4):669-689. doi:10.1016/j.athoracsur.2023.12.006. Shen Z, Mi S, Huang C, Zhou D. Home-based mobile-guided exercise-based cardiac rehabilitation among patients undergoing transcatheter aortic valve replacement (REHAB-TAVR): protocol for a randomised clinical trial. BMJ Open . 2024;14(3):e080042. doi:10.1136/bmjopen-2023-080042. Li Y-S, Ren Q, Mu X-B, et al. Long-term efficacy and safety of moderate-intensity continuous training of cardiopulmonary function in patients after TAVR: extended follow-up of the ENERGY study. Scientific Reports. 2025;15:28344. doi:10.1038/s41598-025-13451-z. Kuneman JH, Butcher SC, Singh GK, et al. Prognostic Implications of Change in Left Ventricular Ejection Fraction After Transcatheter Aortic Valve Implantation. American Journal of Cardiology. 2022;177:90-99. doi:10.1016/j.amjcard.2022.04.060. Brodersen F, Wagner J, Uzunoglu FG, Petersen-Ewert C. Impact of Preoperative Patient Education on Postoperative Recovery in Abdominal Surgery: A Systematic Review. World Journal of Surgery. 2023;47(4):937–947. Suen WL, Bhasin S, Betti V, Bruckel JT, Oldham MA. Mental Health and Transcatheter Aortic Valve Replacement: A Scoping Systematic Review. General Hospital Psychiatry. 2024;86:10–23. doi:10.1016/j.genhosppsych.2023.11.009. Yang Z, Jia H, Wang A. Predictors of home-based cardiac rehabilitation exercise adherence among patients with chronic heart failure: a theory-driven cross-sectional study. BMC Nursing. 2023;22:415. doi:10.1186/s12912-023-01566-5. Tsujimoto K, Watanabe S, Kondo T, Kawabata S, Okura H. Effects of Early Gait Training on Inpatient Frailty After Transcatheter Aortic Valve Implantation. Cureus. 2024;16(6):e63086. doi:10.7759/cureus.63086. Purcell C, Dibben G, Hilton Boon M, et al. Social network interventions to support cardiac rehabilitation and secondary prevention in the management of people with heart disease. Cochrane Database of Systematic Reviews. 2023;6:CD013820. doi:10.1002/14651858.CD013820.pub2. Günaydin S, Keskin H, Tekin G, et al. Enhanced recovery after cardiac surgery and developments in perioperative care: a comprehensive review. J Cardiothorac Surg. 2024;19:344. doi:10.1186/s13019-024-02836-1. de Moura JFC, Oliveira CB, Freire APCF, Elkins MR, Pacagnelli FL. Preoperative respiratory muscle training reduces the risk of pulmonary complications and the length of hospital stay after cardiac surgery: a systematic review. J Physiother. 2024;70(1):16–24. doi:10.1016/j.jphys.2023.10.012. Zhang Y-y, Cui L-X, Zhang L, Wang Y. Continuous nursing care improving outcomes of patients after percutaneous coronary intervention. Medicine (Baltimore). 2024;103(48):e40807. Wang M, Lu X, Du Y, et al. Digital health governance in China by a whole-of-society approach. npj Digital Medicine. 2025;8:496. Cruz-Cobo C, Bernal-Jiménez MÁ, Calle G, et al. Efficacy of a Mobile Health App (eMOTIVA) Regarding Compliance With Cardiac Rehabilitation Guidelines in Patients With Coronary Artery Disease: Randomized Controlled Clinical Trial. JMIR mHealth and uHealth. 2024;12:e11310647. Shen Z, Mi S, Huang C, Zhou D. Home-based mobile-guided exercise-based cardiac rehabilitation among patients undergoing transcatheter aortic valve replacement (REHAB-TAVR): protocol for a randomised clinical trial. BMJ Open. 2024;14:e080042. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 16 Oct, 2025 Reviewers invited by journal 06 Oct, 2025 Editor assigned by journal 01 Oct, 2025 Editor invited by journal 09 Sep, 2025 Submission checks completed at journal 09 Sep, 2025 First submitted to journal 09 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7514382","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":530680521,"identity":"bec8ceb6-a429-4bbf-9f54-99641ae3bfe2","order_by":0,"name":"Shaoping Lin","email":"","orcid":"","institution":"Jinshazhou Hospital of Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Shaoping","middleName":"","lastName":"Lin","suffix":""},{"id":530680522,"identity":"442085ec-5243-4ace-926e-dfccf2ad736f","order_by":1,"name":"Meizhen Guan","email":"","orcid":"","institution":"Jinshazhou Hospital of Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Meizhen","middleName":"","lastName":"Guan","suffix":""},{"id":530680523,"identity":"c59ed363-f2f3-43d6-8797-f8e84b42830f","order_by":2,"name":"Jiaxin Li","email":"","orcid":"","institution":"Jinshazhou Hospital of Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jiaxin","middleName":"","lastName":"Li","suffix":""},{"id":530680524,"identity":"3b312638-a412-4187-a3de-ea618485860b","order_by":3,"name":"Lian Lin","email":"","orcid":"","institution":"Jinshazhou Hospital of Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Lian","middleName":"","lastName":"Lin","suffix":""},{"id":530680527,"identity":"5262869e-ca7e-40fe-9ec5-c857aaaf291b","order_by":4,"name":"Jiezhen Liu","email":"","orcid":"","institution":"Jinshazhou Hospital of Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jiezhen","middleName":"","lastName":"Liu","suffix":""},{"id":530680531,"identity":"9b3e68dc-6de1-401a-bfe3-658dfd7be66d","order_by":5,"name":"Cuicui Feng","email":"","orcid":"","institution":"Jinshazhou Hospital of Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Cuicui","middleName":"","lastName":"Feng","suffix":""},{"id":530680532,"identity":"7de5f45d-bab3-48ac-b5fe-d8445086f095","order_by":6,"name":"Fangfang Lin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwUlEQVRIiWNgGAWjYBAC+/bmww8kKv7J8ROtxYDnWJqBxZkDxpINRGuRyDGQqGw5kLjhALFazBlyDAxuNtwxNj6evIHhR8U2wlosG44VPJy545mc2ZlnBYw9Z24TYc3B5g3GkmeYjc1u5BgwM7YRo+Uwg4H03zbmxM0ziNVicIzFQEKy7XDiBglitUj2sKUZSJxJM5YA+uUgUX7hl38MikobOf725I0PflQQ4xcESDA4QJJ6sBZSdYyCUTAKRsEIAQD04kNIpPv6pwAAAABJRU5ErkJggg==","orcid":"","institution":"Jinshazhou Hospital of Guangzhou University of Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Fangfang","middleName":"","lastName":"Lin","suffix":""}],"badges":[],"createdAt":"2025-09-02 07:08:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7514382/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7514382/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93775784,"identity":"bc595a7e-1a9e-4adf-921f-befed06b7483","added_by":"auto","created_at":"2025-10-17 12:33:22","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":577852,"visible":true,"origin":"","legend":"","description":"","filename":"20250909revised.docx","url":"https://assets-eu.researchsquare.com/files/rs-7514382/v1/4fd0f1b58872e6aaf31f47f5.docx"},{"id":93775778,"identity":"467bf4b7-155b-4cac-903c-d63a21336173","added_by":"auto","created_at":"2025-10-17 12:33:22","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9468,"visible":true,"origin":"","legend":"","description":"","filename":"f55f7b40e2854161911c57228473038a.json","url":"https://assets-eu.researchsquare.com/files/rs-7514382/v1/6a7126484a476aad98597d3e.json"},{"id":93777478,"identity":"66695664-a276-470b-9ca7-d8e3960eda34","added_by":"auto","created_at":"2025-10-17 12:41:22","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":85993,"visible":true,"origin":"","legend":"","description":"","filename":"f55f7b40e2854161911c57228473038a1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7514382/v1/9c4ba4b13784c1242c9151ec.xml"},{"id":93775785,"identity":"65b0471e-8337-489f-9815-97f691983881","added_by":"auto","created_at":"2025-10-17 12:33:22","extension":"png","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":537024,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7514382/v1/3a69212a70f84c4743cba700.png"},{"id":93775779,"identity":"82acd0c4-638e-46e5-835d-28f5ca6d9b1f","added_by":"auto","created_at":"2025-10-17 12:33:22","extension":"png","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":106678,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7514382/v1/97c4cd72095482e7c6a2c3ee.png"},{"id":93775782,"identity":"b0b20b48-df30-4b66-905d-e5bb0630e610","added_by":"auto","created_at":"2025-10-17 12:33:22","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":83024,"visible":true,"origin":"","legend":"","description":"","filename":"f55f7b40e2854161911c57228473038a1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7514382/v1/84b86af3263675bd60b22750.xml"},{"id":93777479,"identity":"3c3d7a20-4f7e-4aa5-85ff-31e64cdec8a9","added_by":"auto","created_at":"2025-10-17 12:41:22","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":92254,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7514382/v1/b02df4e8f2b0d858a1ba3cad.html"},{"id":93775781,"identity":"fa91e4af-1dda-4121-be00-a29a4c58b539","added_by":"auto","created_at":"2025-10-17 12:33:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":275344,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7514382/v1/416dfa05d725032990d5a19e.png"},{"id":93778858,"identity":"e4159f6d-fe54-4d72-a114-08c23074ea8c","added_by":"auto","created_at":"2025-10-17 12:49:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1909332,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7514382/v1/0698842b-1b72-4f5e-9ac5-40b85bed9155.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical effectiveness of an information platform–enabled multidisciplinary Enhanced Recovery After Surgery (ERAS) programme for patients undergoing transcatheter aortic valve replacement (TAVR)","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSince its introduction, transcatheter aortic valve implantation (TAVI) has been offered primarily to older adults with severe aortic stenosis who carry multiple high-risk factors for open surgery; however, as an interventional modality it remains associated with delayed recovery of self-care, prolonged hospitalization, and suboptimal long-term quality of life [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Among these elderly, multimorbid patients, the post-discharge phase is characterized by a protracted rehabilitation course [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], a continuing need for scheduled reassessment and long-term follow-up, and heightened concerns regarding the safety of healthcare activities [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In line with contemporary care imperatives, there is a need to devise rehabilitation pathways that mitigate risk through specialized, individualized interventions for high-risk populations and that can be seamlessly extended into the home setting after discharge. Accordingly, beginning in September 2022, we convened a multidisciplinary team (MDT) and deployed a WeChat-based digital platform to integrate a suite of discipline-specific rehabilitation measures, advancing an outcome-evaluation\u0026ndash;driven, full-course enhanced recovery after surgery (ERAS) model for patients undergoing TAVI [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This approach reduced postoperative stress responses and complications and accelerated recovery, yielding favorable clinical effects.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Inclusion and exclusion criteria\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003eInclusion criteria:\u003c/strong\u003e (i) candidates meeting indications for transcatheter aortic valve replacement (TAVR; also termed TAVI); (ii) able to use a smartphone independently with adequate reading and comprehension; (iii) procedure performed during the index hospitalization; (iv) intact consciousness with effective communication.\u003cbr\u003e\u003cstrong\u003eExclusion criteria:\u003c/strong\u003e (i) critically ill patients or those with cerebrovascular disease or other malignancies; (ii) severe cognitive impairment, psychiatric disorders, or speech/language disorders limiting communication; (iii) inability to complete \u0026ge;12 months of follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Study population\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;We adopted a non-contemporaneous (before\u0026ndash;after) controlled design. Patients undergoing TAVR from 2020 to August 2023 (n=76) received routine care and comprised the control group. From September 2023 onward, patients (n=78) received routine care plus an information-platform\u0026ndash;enabled enhanced recovery programme (intervention group). The study was approved by the institutional ethics committee, and all participants provided written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Study procedures\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003e2.3.1 Control group\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Before surgery, patients attended a standard group briefing in which nurses provided verbal education on the procedure and preoperative preparation. Postoperatively, patients followed medical orders to avoid unnecessary tubing and to remove drains/catheters as early as appropriate; early ambulation was encouraged. Nurses explained the importance of rehabilitation exercises and adherence to a nutritional plan, and demonstrated deep-breathing and effective coughing. After discharge, patients were instructed to attend scheduled clinic visits and to participate in outpatient cardiac rehabilitation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.2 Intervention group\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003e2.3.2.1 Information-platform ERAS\u0026ndash;MDT structure\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;A multidisciplinary team (MDT) supported an information-platform\u0026ndash;enabled ERAS pathway: physicians held overall responsibility for procedural planning and longitudinal oversight; the ward head nurse supervised and coordinated MDT operations; six rehabilitation therapists assessed exercise capacity and nutritional status and designed/provided comprehensive cardiopulmonary rehabilitation across the care continuum; and a six-member nursing team maintained and updated platform content, motivated and coached patients to implement ERAS effectively, and assisted with rehabilitation evaluation and feedback.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.2.2 Specific implementation of the information-platform ERAS programme\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Leveraging the WeChat ecosystem, an A5 QR code poster was placed at each bedside and on the ward education board to operationalise a four-stage intervention spanning admission, surgery preparation, postoperative care, and home-based continued rehabilitation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(i) Admission-phase intervention.\u003c/strong\u003e Upon ward entry, and after obtaining consent, nurses guided patients to scan the QR code and follow the official WeChat account. The system automatically pushed admission instructions and a user guide to the platform, enabling initial familiarization with a contact-free mode of knowledge delivery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(ii) Preoperative intervention.\u003c/strong\u003e The ERAS\u0026ndash;MDT performed individualized assessments of exercise capacity and nutritional status and provided guidance on pain self-assessment. Based on the rehabilitation plan devised by therapists, nurses used the WeChat account to deliver tailored education through multimodal materials (text-and-image posts, videos, animations, and comics). The team first introduced the overall pathway and pushed an animated illustration of the surgical procedure to enhance understanding of the treatment plan. Self-care lessons and nutrition/exercise plans were then scheduled as daily pushes aligned with clinical steps. Detailed videos demonstrated specific rehabilitation movements\u0026mdash;such as cardiopulmonary/respiratory-muscle training, supine ankle-pump exercises, bedside standing drills, and 6-minute walk practice\u0026mdash;and post-reading questionnaires were used to ascertain patient needs. Education was contact-free and reiterative; nurses assessed preoperative learning and mastery before surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(iii) Postoperative intervention.\u003c/strong\u003e Rehabilitation therapists evaluated patients daily. The information-platform ERAS\u0026ndash;MDT continuously reviewed each patient\u0026rsquo;s status to facilitate early removal of tubes, perform targeted pain assessments with analgesia adjustments, restore nutritional parameters promptly, and initiate early in-bed limb activity and assisted ambulation. The platform disseminated success stories and interactive talks to bolster confidence and motivation and to reinforce adherence to early functional training. When repetition was needed, patients could consult the account\u0026rsquo;s \u0026ldquo;History\u0026rdquo; archive to review prior content at any time. Therapists adjusted programme content and intensity in real time, while nurses evaluated learning and execution against the individualized WeChat rehabilitation plan and provided ongoing assessment and feedback.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(iv) Home-based intervention.\u003c/strong\u003e Using the platform\u0026rsquo;s rehabilitation \u003cstrong\u003echeck-in\u003c/strong\u003e and online class-booking features, patients were encouraged to schedule group sessions after discharge and to participate in home exercises via live video, thereby supporting adherence to ERAS and enabling continuous outcome evaluation. For questions arising at home, patients could leave messages or enter keywords to receive bundled, continuously updated topic materials, facilitating long-term learning and dissemination of rehabilitation knowledge to patients and family members.\u003c/p\u003e\n\u003cp\u003eThe intervention arm was advanced in an outcome-evaluation-driven manner, with the MDT overseeing progress and adapting the plan in a timely fashion (Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Outcome measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4.1 Knowledge of TAVI under ERAS.\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;A self-developed questionnaire was used to assess patients\u0026rsquo; knowledge of TAVI within the ERAS pathway in both groups. The instrument comprises 37 items across four dimensions; higher scores denote better knowledge. Internal consistency was high (Cronbach\u0026rsquo;s \u0026alpha;=0.905), with a validity coefficient of 0.929.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4.2 Early frailty and functional capacity.\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Frailty was evaluated using the Fried frailty phenotype across five dimensions, categorising scores \u0026ge;3 as frail (frailty syndrome), 1\u0026ndash;2 as pre-frail, and 0 as robust. Functional capacity was assessed with the Barthel Index (BI), where higher scores indicate greater independence in activities of daily living.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4.3 Length of stay.\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Length-of-stay outcomes included intensive care unit stay, postoperative ward stay, and total hospital stay.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4.4 Long-term quality of life.\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Subjective quality of life was measured using the 12-Item Short Form Health Survey (SF-12), covering six domains\u0026mdash;general health, physical functioning, vitality, bodily pain, mental health, and social functioning\u0026mdash;with higher scores indicating better status. Objective cardiac function was evaluated by the 6-minute walk test (6MWT) obtained postoperatively for comparison, and by transthoracic echocardiography at 1, 3, 6, and 12 months after discharge, focusing on left ventricular ejection fraction (LVEF). Higher overall scores reflected better long-term quality of life [8-9].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 Statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnalyses were conducted using SPSS 26.0. For continuous variables, normality was assessed with the Kolmogorov\u0026ndash;Smirnov test. Normally distributed data are presented as mean\u0026plusmn;SD and compared using independent-samples t tests. Non-normally distributed data are expressed as median (Q1, Q3) and compared with the Wilcoxon rank-sum test. Categorical variables are summarised as n (%) and compared using the \u0026chi;\u0026sup2; test. Two-tailed P\u0026lt;0.01 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Comparison of baseline characteristics between groups\u003c/h2\u003e\u003cp\u003eSex, age, educational attainment, number of baseline comorbidities, and Mini-Mental State Examination (MMSE) scores did not differ significantly between groups (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.01; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), indicating good comparability.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics of the control and intervention groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003egroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eSex, n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAge, years, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c8\" namest=\"c5\"\u003e\u003cp\u003eEducation level, n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003eBaseline comorbidities\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePrimary school or below\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eJunior middle school\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSenior high school/technical secondary\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eJunior college or above\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eBaseline comorbidities\u0026thinsp;\u0026ge;\u0026thinsp;3, n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eMMSE, median (Q1, Q3)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22(28.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54(71.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e73.37\u0026thinsp;\u0026plusmn;\u0026thinsp;6.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18(23.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e26(34.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e21(27.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11(14.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e72(94.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e23.00(19.75,26.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntervention (n\u0026thinsp;=\u0026thinsp;78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33(42.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45(57.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e73.35\u0026thinsp;\u0026plusmn;\u0026thinsp;7.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e27(34.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23(29.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e17(21.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11(14.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e70(89.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e22.00(21.00,24.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eχ\u0026sup2;/t/Z\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e2.993\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c8\" namest=\"c5\"\u003e\u003cp\u003e2.379\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.336\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.953\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e0.084\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.984\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c8\" namest=\"c5\"\u003e\u003cp\u003e0.498\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.248\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.341\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Comparison of awareness of infection-prevention and TAVI-within-ERAS knowledge between groups\u003c/h2\u003e\u003cp\u003eBefore the intervention, scores were uniformly low in both groups and did not differ significantly (P\u0026thinsp;\u0026gt;\u0026thinsp;0.01). After the intervention, the intervention group achieved higher scores than the control group across all three subdomains\u0026mdash;TAVI knowledge, ERAS-oriented nutritional management, and ERAS functional training\u0026mdash;with statistically significant between-group differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of awareness of infection-prevention and TAVI health-education content\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEvaluation index\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;76)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eIntervention (n\u0026thinsp;=\u0026thinsp;78)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eZ1\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eZ2\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP2\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost-intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePre-intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePost-intervention\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTAVI knowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.00(4.00,7.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.00(6.00,8.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.00(5.00,7.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.00(9.00,10.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.594\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6.716\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eERAS nutritional management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.00(1.00,6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.00(6.00,9.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.00(2.00,7.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.00(9.00,10.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.819\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5.494\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eERAS functional training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.00(4.00,6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.00(5.00,8.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.00(4.00,6.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.00(8.00,9.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.997\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6.925\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eNote: Data are median (Q1, Q3). Z1 and P1 denote between-group comparisons before intervention; Z2 and P2 denote between-group comparisons after intervention. Two-tailed significance threshold P\u0026thinsp;\u0026lt;\u0026thinsp;0.01 as prespecified.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Comparison of early frailty and functional capacity between groups\u003c/h2\u003e\u003cp\u003ePostoperative frailty assessments showed a lower proportion of patients meeting criteria for the frailty syndrome in the intervention group than in controls. Postoperative activity scores were significantly higher in the intervention group than in the control group. All differences were statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePostoperative frailty status and activity capacity\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative metric\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;76)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntervention (n\u0026thinsp;=\u0026thinsp;78)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;/t\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFried frailty phenotype, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27.755\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRobust\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(1.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(6.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre-frail\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41(53.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55(70.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFrailty syndrome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34(44.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18(23.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBarthel Index, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (points)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57.24\u0026thinsp;\u0026plusmn;\u0026thinsp;18.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65.20\u0026thinsp;\u0026plusmn;\u0026thinsp;18.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-2.752\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Comparison of ICU and hospitalization durations between groups\u003c/h2\u003e\u003cp\u003eThe intervention group showed significantly shorter intensive care unit (ICU) stay, postoperative ward stay, and total length of hospitalization than the control group (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.01; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLengths of ICU stay and hospitalization\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative metric\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;76)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntervention (n\u0026thinsp;=\u0026thinsp;78)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eZ\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eICU stay, days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.00(4.00,7.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.50(2.00,5.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.689\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative ward stay, days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.00(9.00,16.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.00(6.00,9.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.949\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal hospital stay, days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20.00(15.00,24.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.00(11.00,17.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.466\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Comparison of long-term quality of life between groups\u003c/h2\u003e\u003cp\u003eBased on the 12-Item Short Form Health Survey (SF-12) and the objective 6-minute walk test (6MWT), both groups exhibited uniformly low scores before the intervention, reflecting mid-to-low quality-of-life levels, with no significant between-group differences (P\u0026thinsp;\u0026gt;\u0026thinsp;0.01). After the intervention, scores improved significantly and the intervention group outperformed the control group, with statistically significant between-group differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01; Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). In addition, echocardiographic left ventricular ejection fraction (EF%) did not differ between groups before intervention (P\u0026thinsp;\u0026gt;\u0026thinsp;0.01). Post-intervention, EF% improved more markedly in the intervention group, and the between-group separation increased over time; all postoperative comparisons were statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01; Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of SF-12 and 6-minute walk test between groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMeasure\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;76)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eIntervention (n\u0026thinsp;=\u0026thinsp;78)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eZ1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eZ2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP2\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost-intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePre-intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePost-intervention\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSF-12 score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e88.00(84.00,92.000)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93.00(90.00,98.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87.00(83.75,90.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e98.00(93.70,10.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.227\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.820\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4.058\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6MWT distance (m)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e311.00(195.50,333.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e320.00(224.00,351.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e286.00(210.00,324.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e346.00(318.50,368.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.361\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.718\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.320\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eNote: Data are median (Q1, Q3). Z1 and P1 denote between-group comparisons before intervention; Z2 and P2 denote between-group comparisons after intervention. Two-tailed significance threshold P\u0026thinsp;\u0026lt;\u0026thinsp;0.01 as prespecified.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of echocardiographic left ventricular ejection fraction (EF%) between groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime point\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;76)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntervention (n\u0026thinsp;=\u0026thinsp;78)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eZ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative EF%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45.00(33.00,55.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.00(40.75,55.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.390\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.164\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerioperative postoperative EF%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56.00(44.00,63.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60.00(52.00,66.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.602\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 month post-op EF%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58.50(44.00,65.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63.00(60.00,68.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.580\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3 months post-op EF%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60.00(54.25,65.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66.00(60.00,70.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.088\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6 months post-op EF%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60.00(54.00,66.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68.00(61.50,70.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.406\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12 months post-op EF%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65.00(60.00,68.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69.50(66.00,70.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.822\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote:Data are median (Q1, Q3). Two-tailed significance threshold P\u0026thinsp;\u0026lt;\u0026thinsp;0.01 as prespecified.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Information-enabled ERAS improves disease knowledge and adherence in patients undergoing TAVI\u003c/h2\u003e\u003cp\u003eHealth education is the primary pillar of the information-enabled ERAS pathway [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Using a digital platform for admission guidance and early preoperative education\u0026mdash;rather than traditional didactic lectures or mass briefings\u0026mdash;reduces crowding and contact, thereby lowering the risk of cross-infection. In contrast to one-way, monotonous delivery via verbal instruction or leaflets, the platform standardises the instructional pathway; content is no longer limited by variability in nurses\u0026rsquo; knowledge, communication skills, or available time, ensuring implementation that is both homogeneous and tailored to each patient. Education for patients and family members is freed from temporal and spatial constraints, allowing flexible, distributed learning. For rehabilitation plans that are not easily mastered at first, videos and animations that deconstruct movements increase engagement, facilitate imitation learning, and help address both infection-control requirements and suboptimal comprehension. Older, multimorbid patients undergoing TAVI frequently experience anxiety [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]; the platform\u0026rsquo;s capacity for repeated viewing and unrestricted sharing with relatives and friends strengthens family and social support [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], reduces psychological burden, and enhances adherence.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003e4.2 Information-enabled ERAS enhances early postoperative mobility after TAVI\u003c/h2\u003e\u003cp\u003eDriven by outcome evaluation, the information-enabled ERAS pathway allows real-time titration to individual pace and variability, strengthening nutrition and functional capacity within patients\u0026rsquo; tolerance thresholds. This approach advances earlier and higher-quality ambulation and exercise, and lowers the incidence of postoperative frailty events in older patients, consistent with the findings of Liu Feifan [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The MDT periodically releases assessment results; patients receive bundled, continuously updated content on the platform, enabling timely refresh of ERAS learning, reducing redundancy at the same rehabilitation stage, and reinforcing confidence. When patients are intolerant or lack support and motivation during the early ICU phase, the platform pushes \u0026ldquo;check-in\u0026rdquo; posts and success-case modules to elicit peer-modeling and vicarious motivation [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], thereby promoting active engagement with early-phase protocols.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e\u003ch2\u003e4.3 Information-enabled ERAS shortens hospitalization and mitigates infection risk after TAVI\u003c/h2\u003e\u003cp\u003eBy accelerating postoperative recovery, the pathway promotes early removal of tubes/drains and early ambulation to reduce complications [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], thereby expediting the return to self-care and shortening both ICU and total hospital length of stay. These benefits not only decrease hospitalization costs and facilitate earlier reintegration into family and society, but also lessen the risk of cross-infection during epidemic periods and reduce the likelihood of other hospital-acquired infections, in line with findings from rehabilitation research [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Moreover, the digital platform provides a convenient conduit for patient\u0026ndash;clinician communication, easing concerns about continuity of ERAS follow-up and strengthening confidence in home-based care after discharge.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e\u003ch2\u003e4.4 Information-enabled ERAS improves long-term quality of life after TAVI\u003c/h2\u003e\u003cp\u003eAt present, some clinical departments rely on ad-hoc WeChat groups and manual guidance to deliver rehabilitation and continuity of care [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Such approaches are prone to information loss, remain labour-intensive, and show limited standardisation [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], making it difficult to support synchronous, remote exercise with continuous, transparent supervision and analytics. In our programme, an online class-booking function sustains engagement with the longitudinal ERAS plan, while the continuous release of image-and-text check-ins enables both clinicians and patients to track implementation and adherence in real time [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Coupled with online consultations and scheduled reassessment of cardiac indices, home self-care can be monitored and adjusted, thereby further improving outcomes. Notably, during periods of home quarantine or epidemic control, ERAS activities can proceed without spatial or temporal constraints, reducing the costs of maintaining rehabilitation and preventing programme interruptions due to lockdowns or on-site capacity limits. In our one-year follow-up, the information-enabled ERAS pathway was associated with progressively greater improvements in left ventricular ejection fraction and cardiopulmonary performance over time, facilitating efficient, precise clinician\u0026ndash;patient communication and guidance, with durable benefits for both parties and enhanced long-term quality of life.\u003c/p\u003e\u003c/div\u003e"},{"header":"Summary","content":"\u003cp\u003eSuccessful TAVI is not the end of treatment. Implementing a long-term ERAS pathway via a digital platform is pragmatically valuable: it addresses gaps across multiple care nodes, conserves hospital resources, strengthens multidisciplinary teamwork, accelerates recovery, and provides a scalable reference for diversified, individualised models of continuity of care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki. Ethical approval was granted by the Ethics Committee of Jinshazhou Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China (Approval No.: [JZSH-EC-2023-278]. Written informed consent was obtained from all participants prior to data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. The manuscript does not contain any individual person’s data (images, videos, or other identifying details) requiring consent for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDe-identified data underlying the findings of this study are available from the corresponding author upon reasonable request, subject to institutional data-sharing policies and patient privacy considerations. Template wording conforms to journal guidance on data availability statements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSL (Shaoping Lin): Conceptualization; Methodology; Investigation; Writing—original draft.\u003c/p\u003e\n\u003cp\u003eMG (Meizhen Guan): Data curation; Formal analysis; Visualization; Writing—review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eJL (Jiaxin Li): Investigation; Project administration; Resources.\u003c/p\u003e\n\u003cp\u003eLL (Lian Lin): Supervision (nursing operations); Methodology; Validation.\u003c/p\u003e\n\u003cp\u003eJZL (Jiezhen Liu): Echocardiographic data acquisition; Formal analysis; Interpretation.\u003c/p\u003e\n\u003cp\u003eFC (Cuicui Feng): Rehabilitation protocol development; Patient education content; Visualization.\u003c/p\u003e\n\u003cp\u003eFFL (Fangfang Lin): Overall supervision; Funding/administrative support; Writing—review \u0026amp; editing; Final approval of the version to be published.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eVahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. \u003cem\u003eEuropean Heart Journal\u003c/em\u003e. 2021;42(36):407\u0026ndash;473. doi:10.1093/eurheartj/ehab395.\u003c/li\u003e\n\u003cli\u003eDamluji AA, Diaz-Castrillon CE, Forman DE, et al. TAVR in Older Adults: Moving Toward a Comprehensive Patient-Centered Care Paradigm. \u003cem\u003eJACC: Advances\u003c/em\u003e. 2024;3:100877. doi:10.1016/j.jacadv.2024.100877.\u003c/li\u003e\n\u003cli\u003eHolierook M, Henstra MJ, Dolman DJ, et al. Higher Edmonton Frail Scale prior to transcatheter Aortic Valve Implantation is related to longer hospital stay and mortality. \u003cem\u003eInternational Journal of Cardiology\u003c/em\u003e. 2024;399:131637. doi:10.1016/j.ijcard.2023.131637.\u003c/li\u003e\n\u003cli\u003eZou J, Deng Y, Zhu L, et al. Impact of cardiac rehabilitation on pre- and post-operative transcatheter aortic valve replacement prognoses. \u003cem\u003eFrontiers in Cardiovascular Medicine\u003c/em\u003e. 2023;10:1164104. doi:10.3389/fcvm.2023.1164104.\u003c/li\u003e\n\u003cli\u003eStrange JE, Holt A, Christensen DM, et al. Frailty and Recurrent Hospitalization After Transcatheter Aortic Valve Replacement. \u003cem\u003eJournal of the American Heart Association\u003c/em\u003e. 2023;12(8):e029264. doi:10.1161/JAHA.122.029264.\u003c/li\u003e\n\u003cli\u003eGrant MC, Crisafi C, Alvarez A, et al. Perioperative Care in Cardiac Surgery: A Joint Consensus Statement by the ERAS Cardiac Society, ERAS Society, and The Society of Thoracic Surgeons (STS). \u003cem\u003eAnnals of Thoracic Surgery\u003c/em\u003e. 2024;117(4):669-689. doi:10.1016/j.athoracsur.2023.12.006.\u003c/li\u003e\n\u003cli\u003eShen Z, Mi S, Huang C, Zhou D. Home-based mobile-guided exercise-based cardiac rehabilitation among patients undergoing transcatheter aortic valve replacement (REHAB-TAVR): protocol for a randomised clinical trial. \u003cem\u003eBMJ Open\u003c/em\u003e. 2024;14(3):e080042. doi:10.1136/bmjopen-2023-080042.\u003c/li\u003e\n\u003cli\u003eLi Y-S, Ren Q, Mu X-B, et al. Long-term efficacy and safety of moderate-intensity continuous training of cardiopulmonary function in patients after TAVR: extended follow-up of the ENERGY study. \u003cem\u003eScientific Reports.\u003c/em\u003e 2025;15:28344. doi:10.1038/s41598-025-13451-z.\u003c/li\u003e\n\u003cli\u003eKuneman JH, Butcher SC, Singh GK, et al. Prognostic Implications of Change in Left Ventricular Ejection Fraction After Transcatheter Aortic Valve Implantation. \u003cem\u003eAmerican Journal of Cardiology.\u003c/em\u003e 2022;177:90-99. doi:10.1016/j.amjcard.2022.04.060.\u003c/li\u003e\n\u003cli\u003eBrodersen F, Wagner J, Uzunoglu FG, Petersen-Ewert C. \u003cstrong\u003eImpact of Preoperative Patient Education on Postoperative Recovery in Abdominal Surgery: A Systematic Review.\u003c/strong\u003e \u003cem\u003eWorld Journal of Surgery.\u003c/em\u003e 2023;47(4):937\u0026ndash;947.\u003c/li\u003e\n\u003cli\u003eSuen WL, Bhasin S, Betti V, Bruckel JT, Oldham MA. \u003cstrong\u003eMental Health and Transcatheter Aortic Valve Replacement: A Scoping Systematic Review.\u003c/strong\u003e \u003cem\u003eGeneral Hospital Psychiatry.\u003c/em\u003e 2024;86:10\u0026ndash;23. doi:10.1016/j.genhosppsych.2023.11.009.\u003c/li\u003e\n\u003cli\u003eYang Z, Jia H, Wang A. \u003cstrong\u003ePredictors of home-based cardiac rehabilitation exercise adherence among patients with chronic heart failure: a theory-driven cross-sectional study.\u003c/strong\u003e \u003cem\u003eBMC Nursing.\u003c/em\u003e 2023;22:415. doi:10.1186/s12912-023-01566-5.\u003c/li\u003e\n\u003cli\u003eTsujimoto K, Watanabe S, Kondo T, Kawabata S, Okura H. \u003cstrong\u003eEffects of Early Gait Training on Inpatient Frailty After Transcatheter Aortic Valve Implantation.\u003c/strong\u003e \u003cem\u003eCureus.\u003c/em\u003e 2024;16(6):e63086. doi:10.7759/cureus.63086.\u003c/li\u003e\n\u003cli\u003ePurcell C, Dibben G, Hilton Boon M, et al. \u003cstrong\u003eSocial network interventions to support cardiac rehabilitation and secondary prevention in the management of people with heart disease.\u003c/strong\u003e \u003cem\u003eCochrane Database of Systematic Reviews.\u003c/em\u003e 2023;6:CD013820. doi:10.1002/14651858.CD013820.pub2.\u003c/li\u003e\n\u003cli\u003eG\u0026uuml;naydin S, Keskin H, Tekin G, et al. \u003cstrong\u003eEnhanced recovery after cardiac surgery and developments in perioperative care: a comprehensive review.\u003c/strong\u003e \u003cem\u003eJ Cardiothorac Surg.\u003c/em\u003e 2024;19:344. doi:10.1186/s13019-024-02836-1.\u003c/li\u003e\n\u003cli\u003ede Moura JFC, Oliveira CB, Freire APCF, Elkins MR, Pacagnelli FL. \u003cstrong\u003ePreoperative respiratory muscle training reduces the risk of pulmonary complications and the length of hospital stay after cardiac surgery: a systematic review.\u003c/strong\u003e \u003cem\u003eJ Physiother.\u003c/em\u003e 2024;70(1):16\u0026ndash;24. doi:10.1016/j.jphys.2023.10.012.\u003c/li\u003e\n\u003cli\u003eZhang Y-y, Cui L-X, Zhang L, Wang Y. Continuous nursing care improving outcomes of patients after percutaneous coronary intervention. \u003cem\u003eMedicine (Baltimore).\u003c/em\u003e 2024;103(48):e40807.\u003c/li\u003e\n\u003cli\u003eWang M, Lu X, Du Y, et al. Digital health governance in China by a whole-of-society approach. \u003cem\u003enpj Digital Medicine.\u003c/em\u003e 2025;8:496. \u003c/li\u003e\n\u003cli\u003eCruz-Cobo C, Bernal-Jim\u0026eacute;nez M\u0026Aacute;, Calle G, et al. Efficacy of a Mobile Health App (eMOTIVA) Regarding Compliance With Cardiac Rehabilitation Guidelines in Patients With Coronary Artery Disease: Randomized Controlled Clinical Trial. \u003cem\u003eJMIR mHealth and uHealth.\u003c/em\u003e 2024;12:e11310647.\u003c/li\u003e\n\u003cli\u003eShen Z, Mi S, Huang C, Zhou D. Home-based mobile-guided exercise-based cardiac rehabilitation among patients undergoing transcatheter aortic valve replacement (REHAB-TAVR): protocol for a randomised clinical trial. \u003cem\u003eBMJ Open.\u003c/em\u003e 2024;14:e080042.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Transcatheter aortic valve implantation, Severe aortic stenosis, Enhanced recovery after surgery, Multidisciplinary collaboration, Digital health platform","lastPublishedDoi":"10.21203/rs.3.rs-7514382/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7514382/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo evaluate, using a digital health\u0026ndash;enabled approach, whether a multidisciplinary enhanced recovery team improves peri-hospital and post-discharge recovery among patients undergoing transcatheter aortic valve implantation (TAVI).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted a non-contemporaneous controlled (before\u0026ndash;after) study. Patients who underwent TAVI between 2023 and August 2024 and received routine care formed the control group. From September 2024 onward, patients undergoing TAVI received routine care augmented by a multidisciplinary enhanced recovery after surgery team (ERAS-MDT) delivered via an information platform, spanning inpatient care through home-based follow-up (intervention group). Outcomes included ERAS knowledge, early frailty, activity/functional capacity, length of stay (LOS), and longer-term quality of life assessed by the 12-Item Short-Form Health Survey (SF-12), 6-minute walk test (6MWT), and echocardiographic left ventricular ejection fraction (LVEF). Group differences were compared using appropriate parametric or non-parametric tests with two-sided significance set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eBaseline characteristics (age, sex, education, and comorbid conditions) did not differ significantly between groups. Relative to controls, the intervention group demonstrated higher ERAS knowledge scores [26.50 (23.00\u0026ndash;29.00) vs 34.00 (32.00\u0026ndash;35.00), P\u0026thinsp;\u0026lt;\u0026thinsp;0.01], a lower prevalence of early frailty [34 (44.74%) vs 18 (23.07%), P\u0026thinsp;\u0026lt;\u0026thinsp;0.01], better activity/functional capacity (57.24\u0026thinsp;\u0026plusmn;\u0026thinsp;18.68 vs 65.20\u0026thinsp;\u0026plusmn;\u0026thinsp;18.87, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and shorter LOS [20.00 (15.00\u0026ndash;24.25) vs 14.00 (11.00\u0026ndash;17.00) days, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01]. Longer-term outcomes also favored the intervention group: SF-12 summary scores [93.00 (90.00\u0026ndash;98.25) vs 98.00 (93.70\u0026ndash;10.00), P\u0026thinsp;\u0026lt;\u0026thinsp;0.01], 6MWT distance [320.00 (224.00\u0026ndash;351.00) vs 338.00 (306.75\u0026ndash;360.00) m, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01], and LVEF [65.00 (60.00\u0026ndash;68.00) vs 69.50 (66.00\u0026ndash;70.00) %, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01] indicated greater improvement compared with controls.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eEmbedding a digital information platform within an ERAS-MDT pathway for TAVI aligns with patients\u0026rsquo; needs for continuous, end-to-end recovery support and is associated with superior knowledge acquisition, reduced early frailty, enhanced functional status, shorter hospitalization, and improved longer-term quality of life.\u003c/p\u003e","manuscriptTitle":"Clinical effectiveness of an information platform–enabled multidisciplinary Enhanced Recovery After Surgery (ERAS) programme for patients undergoing transcatheter aortic valve replacement (TAVR)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-17 12:33:17","doi":"10.21203/rs.3.rs-7514382/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"236563286478548877734424024373182099937","date":"2025-10-16T11:53:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-06T13:22:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-01T18:32:13+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-09T10:22:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-09T10:03:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-09-09T10:00:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5dbe6e91-92cc-4f8c-a2a8-6312c5fe3685","owner":[],"postedDate":"October 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-17T12:33:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-17 12:33:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7514382","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7514382","identity":"rs-7514382","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}