Valentine K D, Marques Felisha, Selberg Alexandra, Flannery Laura, Langer Nathaniel, Inglessis Ignacio, Passeri Jonathan, Sundt Thoralf, Sepucha Karen, Elmariah Sammy
Department of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts.
J Soc Cardiovasc Angiogr Interv. 2022 Apr 11;1(2):100025. doi: 10.1016/j.jscai.2022.100025. eCollection 2022 Mar-Apr.
Clinical guidelines recommend patients with aortic stenosis (AS) being considered for transcatheter aortic valve implantation or surgical aortic valve replacement to participate in shared decision-making (SDM) with a heart valve team (HVT). Data supporting these recommendations are limited. This project gathered data on feasibility and preliminary efficacy of a decision aid (DA) in decision-making for patients with severe AS deciding between transcatheter aortic valve implantation and surgical aortic valve replacement.
This institutional review board-approved randomized pilot trial assigned eligible patients to receive either the American College of Cardiology's DA for patients with AS or usual care. Patients were surveyed after their visit regarding knowledge, treatment-preference concordance, SDM (SDM process and CollaboRATE Scales), and decisional conflict. Patients were followed for 3 months to collect data on treatment received.
Of 62 patients approached, 59 (95%) consented and participated. The average age of participants was 72 years, they were 100% white, and 32% of them were female. Intervention patients had higher knowledge scores (75.6 vs 65.5) and more frequently reported CollaboRATE top scores (67% vs 33%) than usual care patients. No other group comparisons reached significance. Patients who saw both members of the HVT before survey completion reported higher SDM process scores than those who saw only 1 specialist (3.1 vs 2.4).
The study exceeded enrollment targets, indicating feasibility. Results suggest the American College of Cardiology's DA improved patient knowledge and communication scores. Patients who met with both members of the HVT reported higher SDM. These observations highlight the importance of SDM and multidisciplinary HVT assessment in the management of severe AS.
临床指南建议，考虑进行经导管主动脉瓣植入术或外科主动脉瓣置换术的主动脉瓣狭窄（AS）患者，应与心脏瓣膜团队（HVT）共同参与决策（SDM）。支持这些建议的数据有限。本项目收集了关于决策辅助工具（DA）在重度AS患者选择经导管主动脉瓣植入术和外科主动脉瓣置换术决策中的可行性和初步疗效的数据。
这项经机构审查委员会批准的随机试点试验，将符合条件的患者分配为接受美国心脏病学会针对AS患者的DA或常规护理。患者就诊后接受关于知识、治疗偏好一致性、SDM（SDM过程和协作率量表）和决策冲突的调查。对患者进行3个月的随访，以收集所接受治疗的数据。
在62名被邀请的患者中，59名（95%）同意并参与。参与者的平均年龄为72岁，全部为白人，其中32%为女性。与接受常规护理的患者相比，干预组患者的知识得分更高（75.6对65.5），且更频繁地报告协作率满分（67%对33%）。其他组间比较均无统计学意义。在调查完成前见到HVT两名成员的患者，其SDM过程得分高于仅见到一名专科医生的患者（3.1对2.4）。
该研究超过了入组目标，表明具有可行性。结果表明，美国心脏病学会的DA提高了患者的知识和沟通得分。与HVT两名成员均会面的患者报告的SDM更高。这些观察结果突出了SDM和多学科HVT评估在重度AS管理中的重要性。
