Design and rationale of a routine clinical care pathway and prospective cohort study in older patients needing intensive treatment.

BACKGROUND: Treatment decisions concerning older patients can be very challenging and individualised treatment plans are often required in this very heterogeneous group. In 2015 we have implemented a routine clinical care pathway for older patients in need of intensive treatment, including a comprehensive geriatric assessment (CGA) that was used to support clinical decision making. An ongoing prospective cohort study, the Triaging Elderly Needing Treatment (TENT) study, has also been initiated in 2016 for participants in this clinical care pathway, to study associations between geriatric characteristics and outcomes of treatment that are relevant to older patients. The aim of this paper is to describe the implementation and rationale of the routine clinical care pathway and design of the TENT study. METHODS: A routine clinical care pathway has been designed and implemented in multiple hospitals in the Netherlands. Patients aged ≥70 years who are candidates for intensive treatments, such as chemotherapy, (chemo-)radiation therapy or major surgery, undergo frailty screening based on the Geriatric 8 (G-8) questionnaire and the Six-Item Cognitive Impairment Test (6CIT). If screening reveals potential frailty, a CGA is performed. All patients are invited to participate in the TENT study. Clinical data and blood samples for biomarker studies are collected at baseline. During follow-up, information about treatment complications, hospitalisations, functional decline, quality of life and mortality is collected. The primary outcome is the composite endpoint of functional decline or mortality at 1 year. DISCUSSION: Implementation of a routine clinical care pathway for older patients in need of intensive treatment provides the opportunity to study associations between determinants of frailty and outcomes of treatment. Results of the TENT study will support individualised treatment for future patients. TRIAL REGISTRATION: The study is retrospectively registered at the Netherlands Trial Register (NTR), trial number NL8107 . Date of registration: 22-10-2019.

Effect of device-guided breathing exercises on blood pressure in patients with hypertension: a randomized controlled trial.

OBJECTIVE: Hypertension is a chronic disorder with a high prevalence worldwide. Despite considerable efforts, it is sometimes hard to reach treatment goals for blood pressure (BP) with classical treatment options. Reducing breathing frequency has been advocated as a method to reduce BP. METHODS: A randomized, single-blind, controlled trial was conducted in 30 non-diabetic patients with hypertension over a period of 9 weeks to evaluate the effect of a device that helps to slow breathing (Resperate) on BP and quality of life (QoL). The control group listened to music and used no other therapeutic device. RESULTS: There was no significant difference in change in BP between intervention and control; BP -4.2 mmHg (95% CI -12.4 to 3.9)/-2.6 mmHg (95% CI -8.4 to 3.3). This result did not alter in post hoc analyses, when patients not achieving target breathing frequency (<10 breaths/min) or non-compliant patients were excluded. QoL did not change over time. CONCLUSIONS: We found no effect of the Resperate on BP or QoL compared with the control group. We conclude that, at this moment, this device has no added value in the treatment of hypertension.