TY - JOUR

T1 - Patients and informal caregivers' experience of surgical and transcatheter aortic valve replacement

T2 - Real-world data contributing to establish value-based medicine in Denmark

AU - Rosseel, Liesbeth

AU - Bieliauskas, Gintautas

AU - Brodersen, Bente B

AU - Olsen, Peter S.

AU - Søndergaard, Lars

AU - De Backer, Ole

PY - 2019

Y1 - 2019

N2 - BACKGROUND: The concept of value-based medicine (VBM) is increasingly implemented in therapeutic decision-making processes, but only few data on patient-perceived values are available in the field of aortic stenosis treatment.HYPOTHESIS: This study aimed to deliver data on patient-perceived values and health-related quality of life (HR-QoL) following surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) in a real-world, all-comers patient population.METHODS: Questionnaires were sent to 637 patients who had undergone elective AVR 12 to 24 months earlier in the period September 2015 to August 2016. The questionnaires were specifically designed to assess physical and mental impact of the entire AVR process on patients and their nearest relative and to capture HR-QoL.RESULTS: Questionnaires were completed by 429 patients (SAVR: N = 265; TAVR: N = 164). Both physical and mental impact of the intervention and its recovery period were experienced more stressful by SAVR as compared with TAVR patients. Also, nearest relatives of SAVR patients experienced the entire process mentally more stressful and enduring than relatives of TAVR patients. In both groups, 10% of patients reported no change in HR-QoL, whereas HR-QoL improved in 76% vs 83% (P = 0.092) and worsened in 14% vs 7% (P = 0.040) of the SAVR and TAVR populations, respectively.CONCLUSION: The perioperative experience tends to be more stressful for SAVR as compared with TAVR patients; however, HR-QoL finally improves to a similar degree in both groups. Given the increasing importance of VBM, patient-perceived values will have to be considered in future decision-making processes, both at individual and public policy-making level.

AB - BACKGROUND: The concept of value-based medicine (VBM) is increasingly implemented in therapeutic decision-making processes, but only few data on patient-perceived values are available in the field of aortic stenosis treatment.HYPOTHESIS: This study aimed to deliver data on patient-perceived values and health-related quality of life (HR-QoL) following surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) in a real-world, all-comers patient population.METHODS: Questionnaires were sent to 637 patients who had undergone elective AVR 12 to 24 months earlier in the period September 2015 to August 2016. The questionnaires were specifically designed to assess physical and mental impact of the entire AVR process on patients and their nearest relative and to capture HR-QoL.RESULTS: Questionnaires were completed by 429 patients (SAVR: N = 265; TAVR: N = 164). Both physical and mental impact of the intervention and its recovery period were experienced more stressful by SAVR as compared with TAVR patients. Also, nearest relatives of SAVR patients experienced the entire process mentally more stressful and enduring than relatives of TAVR patients. In both groups, 10% of patients reported no change in HR-QoL, whereas HR-QoL improved in 76% vs 83% (P = 0.092) and worsened in 14% vs 7% (P = 0.040) of the SAVR and TAVR populations, respectively.CONCLUSION: The perioperative experience tends to be more stressful for SAVR as compared with TAVR patients; however, HR-QoL finally improves to a similar degree in both groups. Given the increasing importance of VBM, patient-perceived values will have to be considered in future decision-making processes, both at individual and public policy-making level.

KW - Aged

KW - Aged, 80 and over

KW - Aortic Valve/surgery

KW - Aortic Valve Stenosis/psychology

KW - Caregivers/psychology

KW - Clinical Decision-Making

KW - Denmark/epidemiology

KW - Female

KW - Follow-Up Studies

KW - Health Status

KW - Humans

KW - Incidence

KW - Male

KW - Prosthesis Design

KW - Quality of Life

KW - Retrospective Studies

KW - Stress, Psychological/epidemiology

KW - Time Factors

KW - Transcatheter Aortic Valve Replacement/methods

U2 - 10.1002/clc.23166

DO - 10.1002/clc.23166

M3 - Journal article

C2 - 30816559

VL - 42

SP - 444

EP - 451

JO - Clinical Cardiology

JF - Clinical Cardiology

SN - 0160-9289

IS - 4

ER -