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. 2022 Aug;9(4):2695-2702.
doi: 10.1002/ehf2.14008. Epub 2022 Jun 8.

Elderly aortic stenosis patients' perspectives on treatment goals in transcatheter aortic valvular replacement

Kohei Sugiura  1 , Takashi Kohno  1   2 , Kentaro Hayashida  1 , Daisuke Fujisawa  3 , Hiroki Kitakata  1 , Naomi Nakano  1 , Tetsuya Saito  1 , Hiromu Hase  1 , Nobuhiro Yoshijima  1 , Hikaru Tsuruta  1 , Yuji Itabashi  1   4 , Shun Kohsaka  1 , Keiichi Fukuda  1
Affiliations

Elderly aortic stenosis patients' perspectives on treatment goals in transcatheter aortic valvular replacement

Kohei Sugiura et al. ESC Heart Fail. 2022 Aug.

Abstract

Aims: Transcatheter aortic valvular replacement (TAVR) is increasingly being performed for elderly patients with aortic stenosis (AS), and current guidelines acknowledge the importance of shared decision-making in their management. This study aimed to evaluate elderly symptomatic severe AS patients' perspectives on their treatment goals and identify factors that influence their treatment choice.

Methods and results: We performed a pre-procedural cross-sectional survey using a questionnaire at a single university hospital. The questionnaire included three primary domains: (i) symptom burden, (ii) goals and important factors related to treatment, and (iii) preferred place of residence after treatment. We investigated 98 symptomatic severe AS patients who underwent TAVR (median age 86 years, 26% men). None of the patients died during hospitalization, and most of them (94%) were discharged home. Prior to TAVR, the three most common symptom burdens were poor mobility (52%), shortness of breath (52%), and weakness (44%). The reported preferred treatment goals were symptom burden reduction (78%), independence maintenance (68%), ability to perform a specific activity/hobby (62%), and improvement in prognosis (58%). In total, 54% of the patients rated 'in alignment with my values' as the factor that affected their decision to undergo TAVR. Nearly all patients (95%) stated that they preferred to live at home after TAVR.

Conclusions: Among elderly AS patients with varying symptoms who underwent TAVR, symptom burden reduction was the most cited patient-reported goal. Nearly all the patients preferred to live at home after the procedure. Encouraging patients to define their specific goals may improve the quality of shared decision-making in such settings.

Keywords: Aortic stenosis; Perspective; Shared decision-making; Transcatheter valvular replacement.

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Conflict of interest statement

Dr. Hayashida is a clinical proctor for Edwards Lifesciences and Medtronic. All the other authors declare there are no conflicts of interest, including those pertaining to related consultancies, shareholdings, and funding grants.

Figures

Figure 1
Figure 1
The proportion of patients' actual (A) and preferred place of living after treatment (B).
Figure 2
Figure 2
Patients' symptom burden during the last month.
Figure 3
Figure 3
Patients' perspectives towards treatment. Patient‐defined treatment goals (A) and factors considered important in the choice of the treatment (B).
See this image and copyright information in PMC

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References

    1. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM 3rd, Thomas JD, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Creager MA, Curtis LH, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Stevenson WG, Yancy CW, American College of Cardiology/American Heart A . AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Thorac Cardiovasc Surg 2014; 2014: e1–e132. - PubMed
    1. Vahl TP, Kodali SK, Leon MB. Transcatheter aortic valve replacement 2016: A modern‐day “through the looking‐glass” adventure. J Am Coll Cardiol 2016; 67: 1472–1487. - PubMed
    1. Lindman BR, Alexander KP, O'Gara PT, Afilalo J. Futility, benefit, and transcatheter aortic valve replacement. JACC Cardiovasc Interv 2014; 7: 707–716. - PMC - PubMed
    1. Baumgartner H, Falk V, Bax JJ, De M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Munoz D, Rosenhek R, Sjogren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL, Group ESCSD . ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 2017; 2017: 2739–2791. - PubMed
    1. Otto CM, Kumbhani DJ, Alexander KP, Calhoon JH, Desai MY, Kaul S, Lee JC, Ruiz CE, Vassileva CM. 2017 ACC expert consensus decision pathway for transcatheter aortic valve replacement in the management of Aaults with aortic stenosis: A report of the American College of Cardiology task force on clinical expert consensus documents. J Am Coll Cardiol 2017; 69: 1313–1346. - PubMed

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