Background: Aortic stenosis (AS) treatments include surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). Choosing between SAVR and TAVR requires patients to trade-off benefits and risks. The objective of this research was to determine which TAVR and SAVR outcomes patients consider important, collect quantitative data about how patients weigh benefits and risks, and evaluate patients' preferences for SAVR or TAVR. Methods: Patients were recruited from advocacy organization databases. Patients self-reported as being diagnosed with AS, and as either having received AS treatment or as experiencing AS-related physical activity limitations. An online adapted swing weighting (ASW) method - a pairwise comparison of attributes - was used to elicit attribute trade-offs from 219 patients. Survey data were used to estimate patients' weights for AS treatment attributes, which were incorporated into a quantitative benefit-risk analysis (BRA) to evaluate patients' preferences for TAVR and SAVR. Results: On average, patients put greater value on attributes that favored TAVR than SAVR. Patients' valuation of the lower mortality rate, reduced procedural invasiveness, and quicker time to return to normal quality of life associated with TAVR, offset their valuation of the time over which SAVR has been proven to work. There was substantial heterogeneity in patients' preferences. This was partly explained by age, with differences in preference observed between patients <60 years to those ≥60 years. A Monte Carlo Simulation found that 79.5% of patients prefer TAVR. Conclusions: Most AS patients are willing to tolerate sizable increases in clinical risk in exchange for the benefits of TAVR, resulting in a large proportion of patients preferring TAVR to SAVR. Further work should be undertaken to characterize the heterogeneity in preferences for AS treatment attributes. Shared decision-making tools based on attributes important to patients can support patients' selection of the procedure that best meets their needs. Copyright:
Background: Aortic stenosis (AS) treatments include surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). Choosing between SAVR and TAVR requires patients to trade-off benefits and risks. The objective of this research was to determine which TAVR and SAVR outcomes patients consider important, collect quantitative data about how patients weigh benefits and risks, and evaluate patients' preferences for SAVR or TAVR. Methods:Patients were recruited from advocacy organization databases. Patients self-reported as being diagnosed with AS, and as either having received AS treatment or as experiencing AS-related physical activity limitations. An online adapted swing weighting (ASW) method - a pairwise comparison of attributes - was used to elicit attribute trade-offs from 219 patients. Survey data were used to estimate patients' weights for AS treatment attributes, which were incorporated into a quantitative benefit-risk analysis (BRA) to evaluate patients' preferences for TAVR and SAVR. Results: On average, patients put greater value on attributes that favored TAVR than SAVR. Patients' valuation of the lower mortality rate, reduced procedural invasiveness, and quicker time to return to normal quality of life associated with TAVR, offset their valuation of the time over which SAVR has been proven to work. There was substantial heterogeneity in patients' preferences. This was partly explained by age, with differences in preference observed between patients <60 years to those ≥60 years. A Monte Carlo Simulation found that 79.5% of patients prefer TAVR. Conclusions: Most AS patients are willing to tolerate sizable increases in clinical risk in exchange for the benefits of TAVR, resulting in a large proportion of patients preferring TAVR to SAVR. Further work should be undertaken to characterize the heterogeneity in preferences for AS treatment attributes. Shared decision-making tools based on attributes important to patients can support patients' selection of the procedure that best meets their needs. Copyright:
Authors: Giuseppe Gargiulo; Anna Sannino; Davide Capodanno; Marco Barbanti; Sergio Buccheri; Cinzia Perrino; Piera Capranzano; Ciro Indolfi; Bruno Trimarco; Corrado Tamburino; Giovanni Esposito Journal: Ann Intern Med Date: 2016-06-07 Impact factor: 25.391
Authors: Domino Determann; Dorte Gyrd-Hansen; G Ardine de Wit; Esther W de Bekker-Grob; Ewout W Steyerberg; Mattijs S Lambooij; Line Bjørnskov Pedersen Journal: Med Decis Making Date: 2019-07-29 Impact factor: 2.583
Authors: Catherine M Otto; Dharam J Kumbhani; Karen P Alexander; John H Calhoon; Milind Y Desai; Sanjay Kaul; James C Lee; Carlos E Ruiz; Christina M Vassileva Journal: J Am Coll Cardiol Date: 2017-01-04 Impact factor: 24.094
Authors: Suzanne J Baron; Suzanne V Arnold; Kaijun Wang; Elizabeth A Magnuson; Khaja Chinnakondepali; Raj Makkar; Howard C Herrmann; Susheel Kodali; Vinod H Thourani; Samir Kapadia; Lars Svensson; David L Brown; Michael J Mack; Craig R Smith; Martin B Leon; David J Cohen Journal: JAMA Cardiol Date: 2017-08-01 Impact factor: 14.676
Authors: Rakesh K Mishra; Wei Yang; Jason Roy; Amanda H Anderson; Nisha Bansal; Jing Chen; Christopher DeFilippi; Patrice Delafontaine; Harold I Feldman; Radhakrishna Kallem; John W Kusek; Claudia M Lora; Sylvia E Rosas; Alan S Go; Michael G Shlipak Journal: Circ Heart Fail Date: 2015-05-18 Impact factor: 8.790
Authors: Samir Kapadia; Shikhar Agarwal; D Craig Miller; John G Webb; Michael Mack; Stephen Ellis; Howard C Herrmann; Augusto D Pichard; E Murat Tuzcu; Lars G Svensson; Craig R Smith; Jeevanantham Rajeswaran; John Ehrlinger; Susheel Kodali; Raj Makkar; Vinod H Thourani; Eugene H Blackstone; Martin B Leon Journal: Circ Cardiovasc Interv Date: 2016-09 Impact factor: 6.546
Authors: Douwe Postmus; Sarah Richard; Nathalie Bere; Gert van Valkenhoef; Jayne Galinsky; Eric Low; Isabelle Moulon; Maria Mavris; Tomas Salmonsson; Beatriz Flores; Hans Hillege; Francesco Pignatti Journal: Oncologist Date: 2017-10-27
Authors: V Lorenzoni; G Barbieri; F Saia; F Meucci; G L Martinelli; A G Cerillo; S Berti; P Candolfi; G Turchetti Journal: Eur J Health Econ Date: 2021-05-21
Authors: Anja Fog Heen; Lyubov Lytvyn; Michael Shapiro; Gordon Henry Guyatt; Reed Alexander Cunningham Siemieniuk; Yuan Zhang; Veena Manja; Per Olav Vandvik; Thomas Agoritsas Journal: Heart Date: 2021-02-09 Impact factor: 5.994