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

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

doi:10.1002/ehf2.14008

Cited by 5 publications

(9 citation statements)

References 34 publications

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“…A second most widely applied SDM step was the exploration of patient wishes and concerns in the decision-making process (step 4)[ 27 , 29 , 32 – 34 , 36 , 37 ]. Description of how the decision was made was described by six studies [ 29 , 34 , 36 , 38 , 39 , 41 ]. Four studies reported about patient’s goals of care regarding immediate care outcomes which can be attributed to the second step of SDM – the key message [ 30 , 35 , 38 , 40 ].…”

Section: Resultsmentioning

confidence: 99%

“…Description of how the decision was made was described by six studies [ 29 , 34 , 36 , 38 , 39 , 41 ]. Four studies reported about patient’s goals of care regarding immediate care outcomes which can be attributed to the second step of SDM – the key message [ 30 , 35 , 38 , 40 ].…”

Section: Resultsmentioning

confidence: 99%

“…Improvement of quality of life through maintaining independence, ability to perform specific activity and symptom mitigation [ 29 – 32 , 35 , 38 , 40 ] as well as life prolongation [ 31 , 32 , 35 , 37 , 38 , 40 ] were the most often reported patient wishes. Lifelong use of anticoagulants, risk of bleeding or blood clot, valve sound, need for reoperations [ 28 , 34 , 37 ], valve lifespan [ 32 ] or other risks like stroke, blood transfusion, prolonged need for ventilations and possibility of dialysis [ 30 ] were some of the main patient concerns that were reported in the included studies.…”

Section: Resultsmentioning

confidence: 99%

“…Lifelong use of anticoagulants, risk of bleeding or blood clot, valve sound, need for reoperations [ 28 , 34 , 37 ], valve lifespan [ 32 ] or other risks like stroke, blood transfusion, prolonged need for ventilations and possibility of dialysis [ 30 ] were some of the main patient concerns that were reported in the included studies. Becoming a burden to the family or society was also a concern some patients expressed [ 38 ]. Further patient concerns were related to the diagnosis, intervention and its benefits, as well as whether the HCPs medical skills are sufficient to ensure a good outcome [ 31 , 40 ].…”

Section: Resultsmentioning

confidence: 99%

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Shared decision making and advance care planning: a systematic literature review and novel decision-making model

Rosca,

Karzig-Roduner,

Kasper

et al. 2023

BMC Med Ethics

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Background and Aims Shared decision making (SDM) and advance care planning (ACP) are important evidence and ethics based concepts that can be translated in communication tools to aid the treatment decision-making process. Although both have been recommended in the care of patients with risks of complications, they have not yet been described as two components of one single process. In this paper we aim to (1) assess how SDM and ACP is being applied, choosing patients with aortic stenosis with high and moderate treatment complication risks such as bleeding or stroke as an example, and (2) propose a model to best combine the two concepts and integrate them in the care process. Methods In order to assess how SDM and ACP is applied in usual care, we have performed a systematic literature review. The included studies have been analysed by means of thematic analysis as well as abductive reasoning to determine which SDM and ACP steps are applied as well as to propose a model of combining the two concepts into one process. Results The search in Medline, Cinahl, Embase, Scopus, Web of science, Psychinfo and Cochrane revealed 15 studies. Eleven describe various steps of SDM while four studies discuss the documentation of goals of care. Based on the review results and existing evidence we propose a model that combines SDM and ACP in one process for a complete patient informed choice. Conclusion To be able to make informed choices about immediate and future care, patients should be engaged in both SDM and ACP decision-making processes. This allows for an iterative process in which each important decision-maker can share their expertise and concerns regarding the care planning and advance care planning. This would help to better structure and prioritize information while creating a trustful and respectful relationship between the participants. PROSPERO 2019. CRD42019124575

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Shared decision making and advance care planning: a systematic literature review and novel decision-making model

Rosca,

Karzig-Roduner,

Kasper

et al. 2023

BMC Med Ethics

View full text Add to dashboard Cite

show abstract

“…Its prevention therefore represents a priority objective across all levels of healthcare in many geographies. From a patient's perspective, stroke represents the most feared complication of TAVR 8,9 . Contemporary stroke rates related to TAVR remain at 2-4% 3,10,11 , with no significant reduction in recent times 3,4 .…”

Section: Introductionmentioning

confidence: 99%

Cerebral embolic protection during transcatheter heart interventions

Jimenez Diaz,

Kapadia,

Linke

et al. 2023

EuroIntervention

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Stroke remains a devastating complication of transcatheter aortic valve replacement (TAVR), with the incidence of clinically apparent stroke seemingly fixed at around 3% despite TAVR's significant evolution during the past decade. Embolic showers of debris (calcium, atheroma, valve material, foreign material) are captured in the majority of patients who have TAVR using a filter-based cerebral embolic protection device (CEPD). Additionally, in systematic brain imaging studies, the majority of patients receiving TAVR exhibit new cerebral lesions. Mechanistic studies have shown reductions in the volume of new cerebral lesions using CEPDs, yet the first randomised trial powered for periprocedural stroke within 72 hours of a transfemoral TAVR failed to meet its primary endpoint of showing superiority of the SENTINEL CEPD. The present review summarises the clinicopathological rationale for the development of CEPDs, the evidence behind these devices to date and the emerging recognition of cerebral embolisation in many non-TAVR transcatheter procedures. Given the uniqueness of each of the various CEPDs under development, specific trials tailored to their designs will need to be undertaken to broaden the CEPD field, in addition to evaluating the role of CEPD in non-TAVR transcatheter heart interventions. Importantly, the cost-effectiveness of these devices will require assessment to broaden the adoption of CEPDs globally. KEYWORDS • aortic stenosis • cerebral protection • mitral valve repair • other • stroke • TAVR AS aortic stenosis CEPD cerebral embolic protection device DW-MRI diffusion-weighted magnetic resonance imaging SAVR surgical aortic valve replacement TAVR transcatheter aortic valve replacement TCD transcranial Doppler

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

et al. 2022

Self Cite

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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 ResultsWe 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.

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

Cited by 5 publications

References 34 publications

Shared decision making and advance care planning: a systematic literature review and novel decision-making model

Shared decision making and advance care planning: a systematic literature review and novel decision-making model

Cerebral embolic protection during transcatheter heart interventions

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

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