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Frank D, Kennon S, Bonaros N, Romano M, Di Mario C, van Ginkel DJ, Bor W, Kasel M, De Backer O, Hachaturyan V, Lüske CM, Kurucova J, Bramlage P, Styra R. Quality of Life Measures in Aortic Stenosis Research: A Narrative Review. Cardiology 2023; 148:556-570. [PMID: 37442111 PMCID: PMC10733944 DOI: 10.1159/000531465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 05/31/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Elderly patients with aortic stenosis (AS) not only have a reduced life expectancy but also a reduced quality of life (QoL). The benefits of an AS intervention may be considered a balance between a good QoL and a reasonably extended life. However, the different questionnaires being used to determine the QoL were generally not developed for the specific situation of patients with AS and come with strengths and considerable weaknesses. The objective of this article was to provide an overview of the available QoL instruments in AS research, describe their strengths and weaknesses, and provide our assessment of the utility of the available scoring instruments for QoL measurements in AS. SUMMARY We identified and reviewed the following instruments that are used in AS research: Short Form Health Survey (SF-36/SF-12), EuroQol-5D (EQ-5D), the Illness Intrusiveness Rating Scale (IIRS), the HeartQoL, the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Minnesota Living with Heart Failure Questionnaire (MLHF), the MacNew Questionnaire, and the Toronto Aortic Stenosis Quality of Life Questionnaire (TASQ). KEY MESSAGES There is no standardized assessment of QoL in patients with AS. Many different questionnaires are being used, but they are rarely specific for AS. There is a need for AS-specific research into the QoL of patients as life prolongation may compete for an improved QoL in this elderly patient group.
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Affiliation(s)
- Derk Frank
- Department of Internal Medicine III (Cardiology, Angiology and Critical Care), UKSH University Clinical Center Schleswig-Holstein and DZHK (German Centre for Cardiovascular Research), Partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Simon Kennon
- Department of Cardiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, UK
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Mauro Romano
- Department of Thoracic and Cardiovascular Surgery, Department of Interventional Cardiology, Hôpital Privé Jacques Cartier, Massy, France
| | - Carlo Di Mario
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Dirk-Jan van Ginkel
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Wilbert Bor
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Markus Kasel
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Ole De Backer
- Interventional Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | | | - Claudia M. Lüske
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Rima Styra
- Department of Psychiatry, University Health Network, Toronto, ON, Canada
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2
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Akbaba A, Erünal M, Ozdamar H, Mert H, Dursun H, Kaya D. Determination of the Fear of COVID-19 and the Quality of Life of Patients With Transcatheter Aortic Valve Implants During the Pandemic. Clin Nurs Res 2022; 31:1422-1430. [PMID: 35676892 DOI: 10.1177/10547738221102275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study aimed to determine the fear of COVID-19 and the quality of life of patients with transcatheter aortic valve implantation (TAVI) during the pandemic. This descriptive cross-sectional study included 132 TAVI patients. Data were collected using a patient information form, the Fear of COVID-19 Scale (FCV-19S), and the EuroQol-5 Dimension (EQ-5D). The mean FCV-19S score of the patients was 17.37 ± 6.12. The mean EQ-5D index score was 0.56 ± 0.37 and the mean VAS score was 65.5 ± 11.5. As per the dimensions of the EQ-5D index, 75% of the patients had mobility problems. According to the logistic regression analysis results, mobility was the most affected parameter, as demonstrated by the worsening in symptoms during the pandemic (odds ratio: 7.370, 95% CI [2.183, 24.881]). The patients with TAVI had a moderate level of fear associated with COVID-19, and the pandemic negatively affected their quality of life.
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Taylor CJ, Ordóñez-Mena JM, Jones NR, Roalfe AK, Myerson SG, Prendergast BD, Hobbs FR. Survival of people with valvular heart disease in a large, English community-based cohort study. Heart 2021; 107:1336-1343. [PMID: 34031157 PMCID: PMC8327406 DOI: 10.1136/heartjnl-2020-318823] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/26/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Valvular heart disease (VHD) is present in half the population aged >65 years but is usually mild and of uncertain importance. We investigated the association between VHD and its phenotypes with all-cause and cause-specific mortality. METHODS The OxVALVE (Oxford Valvular Heart Disease) population cohort study screened 4009 participants aged >65 years to establish the presence and severity of VHD. We linked data to a national mortality registry and undertook detailed outcome analysis. RESULTS Mortality data were available for 3511 participants, of whom 361 (10.3%) died (median 6.49 years follow-up). Most had some form of valve abnormality (n=2645, 70.2%). In adjusted analyses, neither mild VHD (prevalence 44.9%) nor clinically significant VHD (moderate or severe stenosis or regurgitation; 5.2%) was associated with increased all-cause mortality (HR 1.20, 95% CI 0.96 to 1.51 and HR 1.47, 95% CI 0.94 to 2.31, respectively). Conversely, advanced aortic sclerosis (prevalence 2.25%) and advanced mitral annular calcification (MAC, 1.31%) were associated with an increased risk of death (HR 2.05, 95% CI 1.28 to 3.30 and HR 2.51, 95% CI 1.41 to 4.49, respectively). Mortality was highest for people with both clinically significant VHD and advanced aortic sclerosis or MAC (HR 4.38, 95% CI 1.99 to 9.67). CONCLUSIONS Advanced aortic sclerosis or MAC is associated with a worse outcome, particularly for patients with significant VHD, but also in the absence of other VHD. Older patients with mild VHD can be reassured about their prognosis. The absence of an association between significant VHD and mortality may reflect its relatively low prevalence in our cohort.
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Affiliation(s)
- Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicholas R Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrea K Roalfe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Saul G Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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4
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Frantzen AT, Eide LSP, Fridlund B, Haaverstad R, Hufthammer KO, Kuiper KKJ, Lauck S, Ranhoff AH, Rudolph JL, Skaar E, Norekvål TM. Frailty Status and Patient-Reported Outcomes in Octogenarians Following Transcatheter or Surgical Aortic Valve Replacement. Heart Lung Circ 2021; 30:1221-1231. [PMID: 33714672 DOI: 10.1016/j.hlc.2020.10.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/23/2020] [Accepted: 10/22/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Frailty status and patient-reported outcomes are especially pertinent in octogenarians following transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) to guide treatment decisions and promote patient-centred care. AIM We aimed to determine if frailty changed 6 months after aortic valve replacement (AVR) in octogenarians, and to describe changes in self-rated health according to frailty status in patients who underwent TAVI or SAVR. METHOD In a prospective cohort study, frailty and self-rated health were measured one day prior to and 6 months after AVR. Frailty status was measured with the Study of Osteoporotic Fracture index. Self-rated health was measured comprehensively with the disease-specific Minnesota Living with Heart Failure Questionnaire, the generic Medical Outcomes Study Short Form-12 questionnaire (SF-12), and two global questions from The World Health Organization Quality of Life Instrument Abbreviated. RESULTS Data were available for 143 consecutive patients (mean age 83±2.7 years, 57% women; 45% underwent TAVI). At baseline, 34% were robust, 27% prefrail, and 39% frail. Overall, there was no change in the distribution of frailty status 6 months after baseline (p=0.13). However, on an individual level 65 patients changed frailty status after AVR (40 patients improved and 25 declined). Improvement in frailty status was common in prefrail (33%; n=13) and frail patients (48%; n=27). Patients had improved self-rated health after AVR, with significant differences between frailty states both at baseline (SF-12 physical: 37.4 [robust], 33.1 [prefrail], 31.6 [frail], p=0.03); SF-12 mental: 51.9 [robust], 50.8 [prefrail], 44.5 [frail], p<0.001); and at the 6-month follow-up (SF-12 physical: 45.4 [robust], 38.3 [prefrail], 32.1 [frail], p<0.001); SF-12 mental: 54.9 [robust], 49.6 [prefrail], 46.8 [frail], p=0.002). CONCLUSIONS Advanced treatment performed in a high-risk population allowed people to improve their self-rated health. Although frailty is associated with poor self-rated health, frailty status does not equal negative outcomes. The frail patients were those who improved most in self-rated physical and mental health. They had the lowest baseline self-rated health scores and had therefore the most to gain.
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Affiliation(s)
| | - Leslie S P Eide
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden
| | - Rune Haaverstad
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | | | - Karel K J Kuiper
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Sandra Lauck
- Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, Canada; School of Nursing, University of British Columbia, Vancouver, Canada
| | - Anette H Ranhoff
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - James L Rudolph
- Center for Gerontology, Brown School of Public Health, Brown University, Providence, USA
| | - Elisabeth Skaar
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway; Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.
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5
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Lauck SB, Achtem L, Borregaard B, Baumbusch J, Afilalo J, Wood DA, Forman J, Cheung A, Ye J, Webb JG. Can you see frailty? An exploratory study of the use of a patient photograph in the transcatheter aortic valve implantation programme. Eur J Cardiovasc Nurs 2020; 20:252–260. [PMID: 33611409 DOI: 10.1177/1474515120953739] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/31/2020] [Accepted: 08/10/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Frailty is an important consideration in the assessment of transcatheter aortic valve implantation patients. The documentation of a patient photograph to augment the objective measurement of frailty has been adopted by some transcatheter aortic valve implantation multidisciplinary (TAVI) programmes. METHODS We used a prospective two-part multimethod study design. In part A, we examined the concordance between the Essential Frailty Toolset (EFT) and the score attributed by healthcare professionals based on visual rating of photographs using kappa estimates and linear regression. In part B, we conducted a content analysis qualitative study to elicit information about how the TAVI multidisciplinary team used photographs to form impressions about frailty. FINDINGS Part A: 94 healthcare professionals (registered nurses/allied health 65%; physicians 35%) rated 40 representative photographs (women 42.5%; mean age 83.4±7.5; mobility aid 40%) between 0 (robust) and 5 (very frail). The estimate of weighted kappa was 0.2575 (95% confidence interval 0.082-0.433), indicating fair agreement between median healthcare professional visual and EFT score, especially when the EFT was 1 or 4. There was significant discordance among raters (kappa estimate 0.110, 95% confidence interval 0.079-0.141). Age, sex and mobility aid did not have a significant effect on score discordance. Part B: 12 members of the TAVI multidisciplinary team (registered nurses 27.5%; physicians 72.5%) were shown a series of six representative patient photographs. The following themes emerged from the data: (a) looking at the outside; (b) thinking about the inside; (c) use but with caution; and (d) a better approach. CONCLUSION A patient photograph offers complementary information to the multimodality assessment of TAVI patients.
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Affiliation(s)
- Sandra B Lauck
- Centre for Heart Valve Innovation, St Paul's Hospital, Canada.,School of Nursing, University of British Columbia, Canada
| | - Leslie Achtem
- Centre for Heart Valve Innovation, St Paul's Hospital, Canada
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Denmark.,Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Denmark
| | | | - Jonathan Afilalo
- Centre for Clinical Epidemiology, Jewish General Hospital, Canada
| | - David A Wood
- Centre for Heart Valve Innovation, St Paul's Hospital, Canada
| | - Jacqueline Forman
- Centre for Heart Valve Innovation, St Paul's Hospital, Canada.,School of Nursing, University of British Columbia, Canada
| | - Anson Cheung
- Centre for Heart Valve Innovation, St Paul's Hospital, Canada
| | - Jian Ye
- Centre for Heart Valve Innovation, St Paul's Hospital, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St Paul's Hospital, Canada
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6
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Lysell E, Wolf A. Patients' experiences of everyday living before and after transcatheter aortic valve implantation. Scand J Caring Sci 2020; 35:788-795. [PMID: 32781491 DOI: 10.1111/scs.12893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/21/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Aortic stenosis (AS) is the most common valvular disease in western countries. Unless treated, it is associated with a poor prognosis. Surgical aortic valve replacement, the gold-standard approach, aims to increase survival and improve quality of life. In recent years, though, transcatheter aortic valve implantation (TAVI) has become the treatment of choice in elderly, high-risk patients who are denied open surgery. To date, however, little is known about their personal psychological experience after undergoing TAVI. AIM This study aimed to explore patients' experiences during everyday life before and after TAVI. METHOD Altogether, 14 elderly Swedish patients (9 women, 5 men), treated with TAVI, were interviewed between 2 and 6 months after the implantation. The interviews were analysed using qualitative content analysis. RESULTS Analysis of the participants' experiences was divided into two domains: before and after, that is, life with AS vs. life after TAVI. From these domains, four categories were derived: (1) adapting to the deteriorating self; (2) feeling disconnected; (3) reconstruction of self; and (4) processing disappointment. CONCLUSIONS Transcatheter aortic valve implantation involves not only adding years to life but also adding life to years. The urge to live an autonomous life in a social context with others is an important argument for undergoing a TAVI procedure. Despite severe illness and demanding rehabilitation, elderly TAVI patients have the ability to regain independence and rebuild their lives when they base their decision to undergo TAVI on personal goals. These findings might be helpful when implementing person-centred care.
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Affiliation(s)
- Eva Lysell
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Region VästraGötaland, Gothenburg, Sweden
| | - Axel Wolf
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital/Östra, Region VästraGötaland, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Costa G, Barbanti M, Picci A, Todaro D, La Spina K, Di Simone E, D’Arrigo P, Criscione E, Valvo R, Reddavid C, Deste W, Sgroi C, Tamburino C, Giuffrida A, Garretto V, Privitera G, Cannizzaro MT, Inserra C, Veroux P. Predictors and safety of next-day discharge in patients undergoing transfemoral transcatheter aortic valve implantation. EUROINTERVENTION 2020; 16:e494-e501. [DOI: 10.4244/eij-d-19-01080] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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8
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Eide LS, Ranhoff AH, Lauck S, Fridlund B, Haaverstad R, Hufthammer KO, Kuiper KKJ, Nordrehaug JE, Norekvål TM. Indwelling urinary catheters, aortic valve treatment and delirium: a prospective cohort study. BMJ Open 2018; 8:e021708. [PMID: 30389757 PMCID: PMC6224736 DOI: 10.1136/bmjopen-2018-021708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/23/2018] [Accepted: 10/05/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To determine whether an association exists between delirium and length of time indwelling urine catheters (IUC) are used in octogenarian patients treated with surgical aortic valve treatment (SAVR) or transcatheter aortic valve implantation (TAVI). DESIGN Prospective cohort study. SETTING Tertiary university hospital covering the western region of Norway. PARTICIPANTS Octogenarian patients undergoing elective SAVR or TAVI and willing to participate in the study were eligible. Patients unable to speak Norwegian were excluded. Between 2011 and 2013, 143 consecutive patients were included, and data from 136 of them are presented. PRIMARY OUTCOME Delirium. RESULTS Logistic regression analysis shows that lower cognitive function was positively associated with delirium (OR 0.86, CI 0.74 to 0.99, p=0.047). Besides, the interaction term in the model shows that IUC use and delirium differed between SAVR and TAVI patients (p=0.04). The difference corresponded to a weaker association between hours of IUC use and delirium for SAVR (OR 1.01, CI: 0.99 to 1.03, p=0.54) compared with that for TAVI (OR 1.04, CI: 1.01 to 1.08, p=0.004). CONCLUSIONS The association between IUC use and delirium is stronger for octogenarian patients treated with TAVI than for patients who received SAVR. Our results revealed a previously unknown association between the number of hours an IUC is used and postoperative delirium in octogenarian patients treated with TAVI.
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Affiliation(s)
- Leslie Sp Eide
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Anette H Ranhoff
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Kavli Research Center for Geriatrics and Dementia, Haraldsplass Hospital, Bergen, Norway
| | - Sandra Lauck
- Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rune Haaverstad
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Karel K J Kuiper
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Tone Merete Norekvål
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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9
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Baumbusch J, Lauck SB, Achtem L, O'Shea T, Wu S, Banner D. Understanding experiences of undergoing transcatheter aortic valve implantation: one-year follow-up. Eur J Cardiovasc Nurs 2017; 17:280-288. [PMID: 29087216 DOI: 10.1177/1474515117738991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is the treatment of choice for frail, older adults with severe symptomatic aortic stenosis. Although research about long-term clinical outcomes is emerging, there is limited evidence from the perspectives of patients and family caregivers on their perceived benefits and challenges after TAVI. AIMS The aim of this study was to describe older adults and family caregivers' perspectives on undergoing TAVI at one year post-procedure. METHODS Qualitative description was the method of inquiry. A purposive sample of 31 patients and 15 family caregivers was recruited from a TAVI programme in western Canada. Semi-structured interviews were conducted with participants one year after TAVI. Data were analysed thematically. RESULTS All participants were satisfied with the decision to undergo TAVI. There were three central themes. First, recovery was experienced in the context of aging and comorbidities, which was shaped by patients' limited options for care and post-procedure symptom burden. Second, reconciling expectations with reality meant that, for some patients, symptom burden remained prevalent and was also influenced by others' expectations. Third, recommendations for recovery related to having information needs met, keeping informed of evolving care processes, and addressing individualised needs for support. CONCLUSIONS The perspectives of participants provide a valuable contribution to the literature about undergoing TAVI. Clinicians need to be attentive to patients' expectations of benefit and temper these with consideration of the individual's broader health situation to provide treatment decision support. Patients and family caregivers also need adequate teaching and support to facilitate safe transition home given the shift towards early discharge after TAVI.
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Affiliation(s)
| | | | | | - Tamar O'Shea
- 1 School of Nursing, University of British Columbia, Canada
| | - Sarah Wu
- 3 Department of Kinesiology, University of Waterloo, Canada
| | - Davina Banner
- 4 School of Nursing, University of Northern British Columbia, Canada
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10
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Barbanti M, Baan J, Spence MS, Iacovelli F, Martinelli GL, Saia F, Bortone AS, van der Kley F, Muir DF, Densem CG, Vis M, van Mourik MS, Seilerova L, Lüske CM, Bramlage P, Tamburino C. Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation - rationale and design of the FAST-TAVI registry. BMC Cardiovasc Disord 2017; 17:259. [PMID: 29017461 PMCID: PMC5635502 DOI: 10.1186/s12872-017-0693-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an increasing trend towards shorter hospital stays after transcatheter aortic valve implantation (TAVI), in particular for patients undergoing the procedure via transfemoral (TF) access. Preliminary data suggest that there exists a population of patients that can be discharged safely very early after TF-TAVI. However, current evidence is limited to few retrospective studies, encompassing relatively small sample sizes. METHODS The Feasibility And Safety of early discharge after Transfemoral TAVI (FAST-TAVI) registry is a prospective observational registry that will be conducted at 10 sites across Italy, the Netherlands and the UK. Patients will be included if they have been scheduled to undergo TF-TAVI with the balloon-expandable SAPIEN 3 transcatheter heart valve (THV; Edwards Lifesciences, Irvine, CA). The primary endpoint is a composite of all-cause mortality, vascular-access-related complications, permanent pacemaker implantation, stroke, re-hospitalisation due to cardiac reasons, kidney failure and major bleeding, occurring during the first 30 days after hospital discharge. Patients will be stratified according to whether they were high or low risk for early discharge (≤3 days) (following pre-specified criteria), and according to whether or not they were discharged early. Secondary endpoints will include time-to-event (Kaplan-Meier) analysis for the primary outcome and its individual components, analysis of the relative costs of early and late discharge, and changes in short- and long-term quality of life. Multivariate logistic regression will be used to identify factors that indicate that a patient may be suitable for early discharge. DISCUSSION The data gathered in the FAST-TAVI registry should help to clarify the safety of early discharge after TF-TAVI and to identify patient and procedural characteristics that make early discharge from hospital a safe and cost-effective strategy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02404467 (registration first received March 23rd 2015).
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Affiliation(s)
- Marco Barbanti
- Catania Division of Cardiology, Ferrarotto Hospital, University of Catania, Via Salvatore Citelli 6, Catania, Italy.
| | - Jan Baan
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Mark S Spence
- Cardiology Department, Royal Victoria Hospital, Belfast, UK
| | - Fortunato Iacovelli
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy.,Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | | | - Francesco Saia
- Cardiovascular and Thoracic Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Douglas F Muir
- Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK
| | - Cameron G Densem
- Department of Interventional Cardiology, Papworth Hospital, Cambridge, UK
| | - Marije Vis
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | - Claudia M Lüske
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Corrado Tamburino
- Catania Division of Cardiology, Ferrarotto Hospital, University of Catania, Via Salvatore Citelli 6, Catania, Italy
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11
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Hansen TB, Berg SK, Sibilitz KL, Zwisler AD, Norekvål TM, Lee A, Buus N. Patient perceptions of experience with cardiac rehabilitation after isolated heart valve surgery. Eur J Cardiovasc Nurs 2017; 17:45-53. [DOI: 10.1177/1474515117716245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Little evidence exists on whether cardiac rehabilitation is effective for patients after heart valve surgery. Yet, accepted recommendations for patients with ischaemic heart disease continue to support it. To date, no studies have determined what heart valve surgery patients prefer in a cardiac rehabilitation programme, and none have analysed their experiences with it. Aims: The purpose of this qualitative analysis was to gain insight into patients’ experiences in cardiac rehabilitation, the CopenHeartVR trial. This trial specifically assesses patients undergoing isolated heart valve surgery. Methods: Semi-structured interviews were conducted with nine patients recruited from the intervention arm of the trial. The intervention consisted of a physical training programme and a psycho-educational intervention. Participants were interviewed three times: 2–3 weeks, 3–4 months and 8–9 months after surgery between April 2013 and October 2014. Data were analysed using qualitative thematic analysis. Results: Participants had diverse needs and preferences. Two overall themes emerged: cardiac rehabilitation played an important role in (i) reducing insecurity and (ii) helping participants to take active personal responsibility for their health. Despite these benefits, participants experienced existential and psychological challenges and musculoskeletal problems. Participants also sought additional advice from healthcare professionals both inside and outside the healthcare system. Conclusions: Even though the cardiac rehabilitation programme reduced insecurity and helped participants take active personal responsibility for their health, they experienced existential, psychological and physical challenges during recovery. The cardiac rehabilitation programme had several limitations, having implications for designing future programmes.
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Affiliation(s)
- Tina B Hansen
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Selina K Berg
- The Heart Centre, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Kirstine L Sibilitz
- The Heart Centre, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ann D Zwisler
- National Centre of Rehabilitation and Palliation, University of Southern Denmark and University Hospital of Odense, Odense, Denmark
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Anne Lee
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Niels Buus
- Faculty of Nursing and Midwifery, University of Sydney, Australia
- St Vincent’s Private Hospital Sydney, Australia
- St Vincent’s Hospital Sydney, Australia
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Eide LSP, Ranhoff AH, Fridlund B, Haaverstad R, Hufthammer KO, Kuiper KKJ, Nordrehaug JE, Norekvål TM. Readmissions and mortality in delirious versus non-delirious octogenarian patients after aortic valve therapy: a prospective cohort study. BMJ Open 2016; 6:e012683. [PMID: 27707832 PMCID: PMC5073576 DOI: 10.1136/bmjopen-2016-012683] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To determine whether postoperative delirium predicts first-time readmissions and mortality in octogenarian patients within 180 days after aortic valve therapy with surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI), and to determine the most common diagnoses at readmission. DESIGN Prospective cohort study of patients undergoing elective SAVR or TAVI. SETTING Tertiary university hospital that performs all SAVRs and TAVIs in Western Norway. PARTICIPANTS Patients 80+ years scheduled for SAVR or TAVI and willing to participate in the study were eligible. Those unable to speak Norwegian were excluded. Overall, 143 patients were included, and data from 136 are presented. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was a composite variable of time from discharge to first all-cause readmission or death. Secondary outcomes were all-cause first readmission alone and mortality within 180 days after discharge, and the primary diagnosis at discharge from first-time readmission. Delirium was assessed with the confusion assessment method. First-time readmissions, diagnoses and mortality were identified in hospital information registries. RESULTS Delirium was identified in 56% of patients. The effect of delirium on readmissions and mortality was greatest during the first 2 months after discharge (adjusted HR 2.9 (95% CI 1.5 to 5.7)). Of 30 first-time readmissions occurring within 30 days, 24 (80%) were patients who experienced delirium. 1 patient (non-delirium group) died within 30 days after therapy. Delirious patients comprised 35 (64%) of 55 first-time readmissions occurring within 180 days. Circulatory system diseases and injuries were common causes of first-time readmissions within 180 days in delirious patients. 8 patients died 180 days after the procedure; 6 (75%) of them experienced delirium. CONCLUSIONS Delirium in octogenarians after aortic valve therapy might be a serious risk factor for postoperative morbidity and mortality. Cardiovascular disorders and injuries were associated with first-time readmissions in these patients.
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Affiliation(s)
- Leslie S P Eide
- Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anette H Ranhoff
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bengt Fridlund
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Rune Haaverstad
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Karel K J Kuiper
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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