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TOPIC

Impact of choice of therapy on patient safety, quality of life and health outcomes

Patients with severe, symptomatic aortic stenosis enjoy better outcomes and access to high-quality care when their care pathways involve TAVI.

About this topic

The cohort of low surgical risk patients1 for whom the SAPIEN 3TM valve is approved2 is younger than in whom previous PARTNERTM randomised trials have been conducted1 (intermediate-3 and high-risk4 patients, including those deemed inoperable5 for SAVR). As can be assumed, these younger patients may have particular expectations. The patient satisfaction of these younger patients may include an even lower tolerance of complications, a desire to return home as soon as possible and an aversion to re-hospitalisation.

These patient expectations tie in with the expected COVID-19 landscape: as most hospitals’ resources will have been allocated to the pandemic, there will be a backlog of patients whose care has been placed on hold. Tackling this backlog will become of utmost importance. Addressing patient expectations such as lower rates of re-hospitalisation will only benefit hospitals post-COVID-19 as this will result in less hospital time for patients, allowing the hospital to release resources and allocate them elsewhere, contributing to shorter waiting times.

TAVI patients have shorter hospital stays6 (which is reduced even further with the TAVI SAPIEN 3TM valve7,8) and reduced rates of complications and re-hospitalisation1,9.

Patient-related benefits and patients’ quality of life have been found to improve fast following transcatheter aortic valve implantation (TAVI) at 30-days post-procedure with the SAPIEN 3TM valve compared with SAVR:1

  • Quicker discharge home (96% for TAVI versus 73.1% for surgical aortic valve replacement (SAVR))9
  • Improved health status, as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) instrument (a 38% change from baseline for TAVI compared with 13% for SAVR)1
  • Improved 6-minute walk distance (+17.2 metres from baseline with TAVI versus -15.2 for SAVR)9

In short, these patients are home sooner, they feel better faster, and they can do more compared with surgical patients, and because patients return home sooner, waiting lists are shorter for their fellow patients (critical in a time of increased need, resulting from all-risk patient suitability): all of which becomes of critical importance during and in the post-COVID-19 landscape. As hospitals attempt to tackle the backlog of patients whose care has been placed on hold during the pandemic, shorter waiting lists will benefit the hospitals’ efficiency.

Patients’ satisfaction with their care is inextricably linked to the hospital in which they are treated, and hospital reputations can be enhanced or damaged by the satisfaction feedback of its patients.9 Hospital Boards and Senior Management are rightly attuned to the Voice of its patients – and the broadened, younger cohort of ssAS patients know how to use their Voice. Consequently, it has never been more important for hospitals to prioritise patient satisfaction.10

 

  1. Mack MJ, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med 2019;380(18):1695–1705.
  2. MedTech dive. Edwards Lifesciences gets CE mark for advanced heart valve. Available from: https://www.medtechdive.com/news/edwards-lifesciences-gets-ce-mark-for-advanced-heart-valve/542531 (accessed March 2020)
  3. Leon MB, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 2016;374(17):1609–20.
  4. Smith CR, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011;364(23):2187–98.
  5. Leon MB, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010;363(17):1597-1607.
  6. Sanchez C, et al. Comparison of Year-Over-Year U.S. Hospital Costs Between Transcatheter Aortic Valve Replacement (TAVR) and Surgical Aortic Valve Replacement (SAVR). J Am Coll Cardiol 2019;74: (Supplement B728):13
  7. Wood DA, et al. The Vancouver 3M (Multidisciplinary, Multimodality, But Minimalist) Clinical Pathway Facilitates Safe Next-Day Discharge Home of Low-, Medium-, and High-Volume Transfemoral Transcatheter Aortic Valve Replacement Centres. JACC Cardiovasc Interv 2019;12:459–69.
  8. Barbanti M, et al. Optimizing patient discharge management after Transfemoral Transcatheter Aortic Valve Implantation: The Multicentre European FAST-TAVI trial. Euro Intervention 2019;15:147–54.
  9. Mack MJ, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients [supplemental appendix]. N Engl J Med 2019;380:1695–705.
  10. NHS. The patient experience book. Available from: https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/11/Patient-Experience-Guidance-and-Support.pdf (accessed May 2020)
 
This content is sponsored by Edwards Lifesciences