دورية أكاديمية
أعرض في EDS

The medically managed patient with severe symptomatic aortic stenosis in the TAVR era: Patient characteristics, reasons for medical management, and quality of shared decision making at heart valve treatment centers.

التفاصيل البيبلوغرافية
العنوان: The medically managed patient with severe symptomatic aortic stenosis in the TAVR era: Patient characteristics, reasons for medical management, and quality of shared decision making at heart valve treatment centers.
المؤلفون: Dharmarajan K; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America.; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, United States of America., Foster J; American College of Cardiology, Washington, DC, United States of America., Coylewright M; Section of Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America., Green P; Division of Cardiology, Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY, United States of America., Vavalle JP; Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America., Faheem O; Prima Care Cardiology, Fall River, MA, United States of America., Huang PH; Sutter Heart & Vascular Institute, Sacramento, CA, United States of America., Krishnaswamy A; Department of Cardiovascular Medicine, Division of Interventional Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America., Thourani VH; Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States of America., McCoy LA; Duke Clinical Research Institute, Durham, NC, United States of America., Wang TY; Duke Clinical Research Institute, Durham, NC, United States of America.
المصدر: PloS one [PLoS One] 2017 Apr 21; Vol. 12 (4), pp. e0175926. Date of Electronic Publication: 2017 Apr 21 (Print Publication: 2017).
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
أسماء مطبوعة: Original Publication: San Francisco, CA : Public Library of Science
مواضيع طبية MeSH: Decision Making* , Patient Participation*, Aortic Valve Stenosis/*surgery , Heart Valve Prosthesis Implantation/*methods, Aged ; Aged, 80 and over ; Cohort Studies ; Female ; Humans ; Male ; Severity of Illness Index
مستخلص: Background: Little is known about patients with severe symptomatic aortic stenosis (AS) who receive medical management despite evaluation at a heart valve treatment center.
Objective: We identified patient characteristics associated with medical management, physician-reported reasons for selecting medical management, and patients' perceptions of their involvement and satisfaction with treatment selection.
Methods and Results: Of 454 patients evaluated for AS at 9 established heart valve treatment centers from December 12, 2013 to August 19, 2014, we included 407 with severe symptomatic AS. Information was collected using medical record review and survey of patients and treating physicians. Of 407 patients, 212 received transcatheter aortic valve replacement (TAVR), 124 received surgical aortic valve replacement (SAVR), and 71 received medical management (no SAVR/TAVR). Thirty-day predicted mortality was higher in patients receiving TAVR (8.7%) or medical management (9.8%) compared with SAVR (3.4%) (P<0.001). Physician-reported reasons for medical management included patient preference (31.0%), medical futility (19.7%), inoperability/anatomic infeasibility (11.3%), and inadequate vascular access (8.5%). Compared with patients receiving AVR, medically managed patients were less likely to report that they received enough information about the pros and cons of treatment options (P = 0.03), that their physicians involved them in treatment decisions (P<0.001), and that final decisions were the right ones (P<0.001).
Conclusions: Patient preference was the most common physician-reported reason for selecting non-invasive AS management, yet patients not undergoing AVR after valve center evaluation reported being less likely to receive sufficient education about treatment options and more likely to feel uncertain about final treatment decisions. Greater attention to shared decision making may improve the experience of care for this vulnerable group of patients.
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معلومات مُعتمدة: K23 AG048331 United States AG NIA NIH HHS; K23 HL121142 United States HL NHLBI NIH HHS; P30 AG021342 United States AG NIA NIH HHS
تواريخ الأحداث: Date Created: 20170422 Date Completed: 20170907 Latest Revision: 20240325
رمز التحديث: 20240325
مُعرف محوري في PubMed: PMC5400246
DOI: 10.1371/journal.pone.0175926
PMID: 28430791
قاعدة البيانات: MEDLINE
الوصف
تدمد:1932-6203
DOI:10.1371/journal.pone.0175926