Key result
Among patients undergoing TAVI, 66.2% reported their pre-treatment goals were met at 6-12 months, though this experience of treatment benefits had poor alignment with functional outcomes.
Why the study?
To improve TAVI patient selection, shared decision-making is recommended to elicit treatment expectations and goals, but data were needed on whether these pre-procedural goals are met and how they align with quality of life and functional recovery.
Does transcatheter aortic valve implantation meet patient-defined treatment goals in patients with severe aortic stenosis?
Observational (n=74)
No
Does transcatheter aortic valve implantation meet patient-defined treatment goals in patients with severe aortic stenosis?
While most TAVI patients report their personal treatment goals are met, this subjective success aligns poorly with objective functional recovery, highlighting the importance of patient-reported outcomes in shared decision-making.
OBJECTIVES: Transcatheter aortic valve implantation (TAVI) is an important treatment option for patients with severe aortic stenosis. To improve patient selection, shared decision-making is recommended to elicit patients' treatment expectations and goals. We assessed patients' expectations and goals before TAVI treatment and whether these were met after treatment. Additionally, we evaluated how meeting these goals aligned with quality of life and functional recovery. DESIGN: A mixed method study. SETTING: An academic medical center. PARTICIPANTS: Seventy-four patients undergoing TAVI between 2015 and 2017. MEASUREMENTS: Patients' expectations and goals were assessed qualitatively before treatment. Six to twelve months post procedure, quality of life was measured with the EuroQuol-5D and any change in the number of dependencies in (instrumental) activities of daily living was assessed. RESULTS: Mean age of patients was 81.5 years, and 37.8% were male. Regaining the ability to engage in a specific hobby or activity was the most important treatment goal (33 patients, 54.1%), followed by reducing symptoms (19 patients 31.1%). 66.2% of patients stated that their treatment goal was met. Quality of life was higher in this group, as compared with patients who had not met their treatment goal. Twenty-three patients (31.1%) showed functional improvement. CONCLUSION: TAVI patients were quite capable of eliciting treatment goals and a majority stated, after treatment, that these had been met patients' experience of treatment benefits regarding these goals had poor alignment with functional outcomes. This raises questions regarding relevant outcome measurements in this population, and could aid in improving shared decision-making and patient selection for TAVI.
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Beishuizen et al. (2021) conducted an observational in severe aortic stenosis (n=74). Transcatheter aortic valve implantation (TAVI) was evaluated on Meeting pre-treatment goals. Among patients undergoing TAVI, 66.2% reported their pre-treatment goals were met at 6-12 months, though this experience of treatment benefits had poor alignment with functional outcomes.
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