Susy Ferrari1, Cristina Ciuca2, Enrica Grisoglio3, Tiziana Claudia Aranzulla4, Davide Gabbieri5, Lavinia Vecchio Verderame6, Flavia Dispensa6, Cinzia Caruso7, Alda Carmela Di Mauro7, Omar Di Gregorio8, Claudia Pandolfi9, Silvia Rongoni9, Giovanni Ottoboni1, Carolina Moretti2, Rossana De Palma10, Antonio Marzocchi2, Rabih Chattat1, Francesco Saia2. 1. Dipartimento di Psicologia, Università degli Studi, Bologna. 2. U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna. 3. SCDU Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza-Molinette, Torino. 4. U.O. Cardiologia, Ospedale Mauriziano Umberto I, Torino. 5. U.O. Cardiochirurgia, Hesperia Hospital, Modena. 6. U.O. Cardiologia, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo. 7. U.O. Cardiologia, Azienda Ospedaliero-Universitaria Policlinico Vittorio Emanuele, Ospedale Ferrarotto, Catania. 8. U.O. Cardiochirurgia, Azienda Sanitaria Ospedaliera S. Croce e Carle, Cuneo. 9. U.O. Cardiologia, A.O. San Camillo-Forlanini, Roma. 10. Agenzia Sociale e Sanitaria Regionale, Regione Emilia-Romagna, Bologna.
Abstract
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a very effective treatment option for patients with severe aortic stenosis who are either not suitable candidates or at high risk for surgical aortic valve replacement (AVR). Patients undergoing TAVI are often very elderly and their clinical status is burdened with multiple comorbidities, therefore evaluation of quality of life (QoL) might be challenging. We sought to provide an overview of available data on QoL changes after TAVI and critical insights on the instruments used to detect these changes. METHODS: This analysis focuses on studies that evaluated QoL after TAVI with standardized questionnaires. Out of 706 items identified through literature search, 23 studies were included in the final review: 2 randomized controlled trials (one comparing QoL pre- vs post-TAVI, one TAVI vs AVR vs medical therapy) and 21 observational studies (19 studies comparing QoL pre- and post-TAVI and 2 studies TAVI vs AVR). The instruments used in all studies were not specific for TAVI patients. RESULTS: Most studies reported a significant improvement in QoL after TAVI, greater for physical aspects compared with psychological components, which persisted at mid and long-term follow-up. A short-term benefit was found for transfemoral TAVI patients as compared with transapical TAVI and AVR; however, these differences tended to disappear over time. CONCLUSIONS: The study highlights an improvement in QoL after TAVI that persists over time. As different instruments resulted to be more sensitive to detect different aspects, multidimensional assessments - capable of combining disease-specific and disease-non-specific measures - should foster clinical research in order to have a more complete picture of QoL of TAVI patients.
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a very effective treatment option for patients with severe aortic stenosis who are either not suitable candidates or at high risk for surgical aortic valve replacement (AVR). Patients undergoing TAVI are often very elderly and their clinical status is burdened with multiple comorbidities, therefore evaluation of quality of life (QoL) might be challenging. We sought to provide an overview of available data on QoL changes after TAVI and critical insights on the instruments used to detect these changes. METHODS: This analysis focuses on studies that evaluated QoL after TAVI with standardized questionnaires. Out of 706 items identified through literature search, 23 studies were included in the final review: 2 randomized controlled trials (one comparing QoL pre- vs post-TAVI, one TAVI vs AVR vs medical therapy) and 21 observational studies (19 studies comparing QoL pre- and post-TAVI and 2 studies TAVI vs AVR). The instruments used in all studies were not specific for TAVI patients. RESULTS: Most studies reported a significant improvement in QoL after TAVI, greater for physical aspects compared with psychological components, which persisted at mid and long-term follow-up. A short-term benefit was found for transfemoral TAVI patients as compared with transapical TAVI and AVR; however, these differences tended to disappear over time. CONCLUSIONS: The study highlights an improvement in QoL after TAVI that persists over time. As different instruments resulted to be more sensitive to detect different aspects, multidimensional assessments - capable of combining disease-specific and disease-non-specific measures - should foster clinical research in order to have a more complete picture of QoL of TAVI patients.
Authors: Katarzyna Olszewska-Turek; Tomasz Tokarek; Artur Dziewierz; Anna Rajtar-Zembaty; Bartosz Partyński; Danuta Sorysz; Barbara Bętkowska-Korpała Journal: Postepy Kardiol Interwencyjnej Date: 2020-04-03 Impact factor: 1.426