Midtveisevaluering - Kjersti Oterhals
Patient-reported outcomes in patients with aortic stenosis with and without aortic valve replacement
Calcific aortic stenosis (AS) is found in 2 - 4% of adults 65 years or older. The most common cause is a degenerative calcific process, which results in leaflet immobility and impaired blood flow through the heart. Aortic valve replacement (AVR) with biological or mechanical valves is the most common surgical valve procedure.
Improvement in self-reported health status is today one of the principal goals of heart valve surgery. Patient-reported outcomes at all stages of AS need to be evaluated. To date, most existing studies include few patients and short follow-up time, and there is a gap in the literature of evaluating health status in patients with AS who have not undergone AVR. In addition, no qualitative studies has been reported on patients with AS.
The main objectives for this study was to explore how patients adapt to living with a mechanical aortic heart valve, and determine long-term results following AVR, with or without concomitant by-pass surgery (CABG), focusing on health status, functional status, psychosocial aspects and survival, and to compare the results with the general population and patients with AS not accepted for surgery.
In Study I an explorative design was applied. Interviews were conducted with 20 patients, aged 24 to 74 years having undergone AVR with mechanical valves during the 10 last years. Findings showed that patients adapted to living with a mechanical heart valve in different ways. Oral anticoagulation therapy was considered to be the most troublesome consequence, but for some also the sound of the valve was difficult to accept. Patient counselling and adequate follow-up can make patients with mechanical aortic heart valves more confident and competent to manage their own health1.
For study II and III data have been collected by a cross-sectional postal survey sent to 1240 patients that had undergone AVR with or without concomitant CABG from January 2000 to December 2011 and 245 patients with AS not undergone AVR. Self-reported socio-demographic data, health status, comorbidities and physical functioning were assessed. In addition baseline clinical characteristics, relevant medical history, cardiovascular risk factors and postoperative complications have been collected prospectively. Data on health status from an age and gender matched general Norwegian population have been provided by the Norwegian Social Science Data Services.
The response rates were 74% in the surgical group and 56 % in the non-surgical group. In Study II we will i) identify the relationship between age, gender and symptoms preoperatively with self-reported health status up to 12 years after surgery, ii) compare self-reported health status in persons with AVR with and without concomitant CABG, and iii) compare self-reported health status in this population with that of the Norwegian general population.
In Study III we aim to determine the long-term survival, functional status and health status of patients operated for AS and those not eligible for surgery, compared to the general Norwegian population, and evaluate the clinical significance of the observations.
1Oterhals K, Fridlund B, Nordrehaug JE, Haaverstad R, Norekvål TM, "Adapting to living with a mechanical aortic heart valve: a phenomenographic study". Journal of Advanced Nursing 2013 Sep;69(9):2088-98.