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Patient values and preferences on valve replacement for aortic stenosis: a systematic review

The review aims to summarise evidence addressing patients’ values, preferences and practical issues on deciding between transcatheter aortic valve insertion (TAVI) and surgical aortic valve replacement (SAVR) for aortic stenosis. We searched databases and grey literature until June 2020. We included...

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Autores principales: Heen, Anja Fog, Lytvyn, Lyubov, Shapiro, Michael, Guyatt, Gordon Henry, Siemieniuk, Reed Alexander Cunningham, Zhang, Yuan, Manja, Veena, Vandvik, Per Olav, Agoritsas, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8327404/
https://www.ncbi.nlm.nih.gov/pubmed/33563630
http://dx.doi.org/10.1136/heartjnl-2020-318334
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author Heen, Anja Fog
Lytvyn, Lyubov
Shapiro, Michael
Guyatt, Gordon Henry
Siemieniuk, Reed Alexander Cunningham
Zhang, Yuan
Manja, Veena
Vandvik, Per Olav
Agoritsas, Thomas
author_facet Heen, Anja Fog
Lytvyn, Lyubov
Shapiro, Michael
Guyatt, Gordon Henry
Siemieniuk, Reed Alexander Cunningham
Zhang, Yuan
Manja, Veena
Vandvik, Per Olav
Agoritsas, Thomas
author_sort Heen, Anja Fog
collection PubMed
description The review aims to summarise evidence addressing patients’ values, preferences and practical issues on deciding between transcatheter aortic valve insertion (TAVI) and surgical aortic valve replacement (SAVR) for aortic stenosis. We searched databases and grey literature until June 2020. We included studies of adults with aortic stenosis eliciting values and preferences about treatment, excluding medical management or palliative care. Qualitative findings were synthesised using thematic analysis, and quantitative findings were narratively described. Evidence certainty was assessed using CERQual (Confidence in the Evidence from Reviews of Qualitative Research) and GRADE (Grading of Recommendations Assessment, Development and Evaluation). We included eight studies. Findings ranged from low to very low certainty. Most studies only addressed TAVI. Studies addressing both TAVI and SAVR reported on factors affecting patients’ decision-making along with treatment effectiveness, instead of trade-offs between procedures. Willingness to accept risk varied considerably. To improve their health status, participants were willing to accept higher mortality risk than current evidence suggests for either procedure. No study explicitly addressed valve reintervention, and one study reported variability in willingness to accept shorter duration of known effectiveness of TAVI compared with SAVR. The most common themes were desire for symptom relief and improved function. Participants preferred minimally invasive procedures with shorter hospital stay and recovery. The current body of evidence on patients’ values, preferences and practical issues related to aortic stenosis management is of suboptimal rigour and reports widely disparate results regarding patients’ perceptions. These findings emphasise the need for higher quality studies to inform clinical practice guidelines and the central importance of shared decision-making to individualise care fitted to each patient.
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spelling pubmed-83274042021-08-19 Patient values and preferences on valve replacement for aortic stenosis: a systematic review Heen, Anja Fog Lytvyn, Lyubov Shapiro, Michael Guyatt, Gordon Henry Siemieniuk, Reed Alexander Cunningham Zhang, Yuan Manja, Veena Vandvik, Per Olav Agoritsas, Thomas Heart Review The review aims to summarise evidence addressing patients’ values, preferences and practical issues on deciding between transcatheter aortic valve insertion (TAVI) and surgical aortic valve replacement (SAVR) for aortic stenosis. We searched databases and grey literature until June 2020. We included studies of adults with aortic stenosis eliciting values and preferences about treatment, excluding medical management or palliative care. Qualitative findings were synthesised using thematic analysis, and quantitative findings were narratively described. Evidence certainty was assessed using CERQual (Confidence in the Evidence from Reviews of Qualitative Research) and GRADE (Grading of Recommendations Assessment, Development and Evaluation). We included eight studies. Findings ranged from low to very low certainty. Most studies only addressed TAVI. Studies addressing both TAVI and SAVR reported on factors affecting patients’ decision-making along with treatment effectiveness, instead of trade-offs between procedures. Willingness to accept risk varied considerably. To improve their health status, participants were willing to accept higher mortality risk than current evidence suggests for either procedure. No study explicitly addressed valve reintervention, and one study reported variability in willingness to accept shorter duration of known effectiveness of TAVI compared with SAVR. The most common themes were desire for symptom relief and improved function. Participants preferred minimally invasive procedures with shorter hospital stay and recovery. The current body of evidence on patients’ values, preferences and practical issues related to aortic stenosis management is of suboptimal rigour and reports widely disparate results regarding patients’ perceptions. These findings emphasise the need for higher quality studies to inform clinical practice guidelines and the central importance of shared decision-making to individualise care fitted to each patient. BMJ Publishing Group 2021-08 2021-02-09 /pmc/articles/PMC8327404/ /pubmed/33563630 http://dx.doi.org/10.1136/heartjnl-2020-318334 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Review
Heen, Anja Fog
Lytvyn, Lyubov
Shapiro, Michael
Guyatt, Gordon Henry
Siemieniuk, Reed Alexander Cunningham
Zhang, Yuan
Manja, Veena
Vandvik, Per Olav
Agoritsas, Thomas
Patient values and preferences on valve replacement for aortic stenosis: a systematic review
title Patient values and preferences on valve replacement for aortic stenosis: a systematic review
title_full Patient values and preferences on valve replacement for aortic stenosis: a systematic review
title_fullStr Patient values and preferences on valve replacement for aortic stenosis: a systematic review
title_full_unstemmed Patient values and preferences on valve replacement for aortic stenosis: a systematic review
title_short Patient values and preferences on valve replacement for aortic stenosis: a systematic review
title_sort patient values and preferences on valve replacement for aortic stenosis: a systematic review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8327404/
https://www.ncbi.nlm.nih.gov/pubmed/33563630
http://dx.doi.org/10.1136/heartjnl-2020-318334
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