TAVR for Aortic Stenosis: Improvement in Quality of Life

MedicalResearch.com Interview with:
Caroline A. Kim, MD, MS;
Beth Israel Deaconess Medical Center
Boston, MA 02215.

MedicalResearch.com: What are the main findings of the study?

Dr. Kim: We conducted a systematic review of 62 studies that examined functional status and quality of life in patients who underwent transcatheter aortic valve replacement (AVR) for their symptomatic severe aortic valve stenosis.  In 11,205 patients who underwent TAVR, a clinically meaningful improvement was seen in physical functional measures and disease-specific quality of life measures, whereas improvement in psychological measures or more general health measures were modest and inconsistent.  Given the dismal prognosis of severe aortic stenosis treated conservatively, it was clear that transcatheter AVR improved functional status and quality of life.  However, there was insufficient evidence that compares these patient-centered outcomes between transcatheter AVR and surgical AVR.
MedicalResearch.com: Were any of the findings unexpected?

Dr. Kim: The majority of studies had major methodological limitations that did not allow accurate estimation of overall benefits of transcatheter AVR.  Although many patients with severe aortic stenosis may place a higher value on improving the quality of life than prolonging survival, we were surprised to learn that most research only focused on procedural success or mortality; very few studies compared transcatheter AVR and surgical AVR.   In most studies, measures of functional status and quality of life other than the New York Heart Association functional class were seldom studied.   Furthermore, it was evident that some patients did not benefit from transcatheter AVR.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Kim: Here are the take-home points from our work:

1) Transcatheter AVR improves survival, physical function, and some measures of quality of life compared with conservative treatment.

2) However, these observed benefits of transcatheter AVR were not observed from all patients treated with transcatheter AVR.  Some did not receive any meaningful benefits.

3) The functional and quality-of-life benefits of transcatheter AVR compared with surgical AVR remain to be examined.  Previous research showed similar survival rates.

4) Until more evidence accrues, clinicians and patients should weight potential risks and benefits of the two procedures, individuals’ risk factors for complications (medical comorbidities and frailty) and life expectancy, to select patients who are most likely to benefit.  This point is not directly supported from our work, but it is a general statement based on current evidence.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Kim:  We call for more prospective studies that compare functional status and quality of life between transcatheter AVR and surgical AVR to better inform clinicians and patients in making treatment decisions for symptomatic severe aortic stenosis.  More research is needed to develop an algorithm that identifies those who are more likely to benefit from transcatheter AVR than surgical AVR.

Citation:

Caroline A. Kim, Suraj P. Rasania, Jonathan Afilalo, Jeffrey J. Popma, Lewis A. Lipsitz, Dae Hyun Kim; Functional Status and Quality of Life After Transcatheter Aortic Valve Replacement
A Systematic Review. Annals of Internal Medicine. 2014 Feb;160(4):243-254.