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Functional status and quality of life after transcatheter aortic valve replacement: a systematic review.

ABSTRACT: BACKGROUND:The functional and quality-of-life benefits of transcatheter aortic valve replacement (TAVR) have not been established. PURPOSE:To evaluate the changes in functional status and quality of life after TAVR. DATA SOURCES:MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from 1 January 2002 to 30 September 2013. STUDY SELECTION:Studies of TAVR that reported the New York Heart Association (NYHA) class, Short Form-12/36 Health Survey physical and mental component summary (points), or other measures of functional status. DATA EXTRACTION:Two reviewers independently extracted the mean change (follow-up minus baseline) in primary outcomes. Because of substantial heterogeneity, data were not pooled; the range of mean change was summarized. DATA SYNTHESIS:We identified 60 observational studies (56 pre–post comparison and 4 head-to-head comparative studies) and 2 randomized, controlled trials (11 205 patients). Most studies showed a clinically important decrease in NYHA class at 6 to 11 months (range, -0.8 to -2.1 classes) and 12 to 23 months (range, -0.8 to -2.1 classes). The improvement in the Short Form-12/36 Health Survey physical component score was clinically important over 12 months (range, 4.9 to 26.9 points), and the change in mental component score was smaller (range, 1.0 to 8.9 points).Clinically important improvements were seen in other disease-specific measures but were less consistently seen in general health measures. LIMITATIONS:Comparative evidence is limited by few head-to-head studies. Survivor bias may have overestimated the benefits. CONCLUSION:Transcatheter aortic valve replacement provides clinically important benefits in physical function and disease-specific measures of quality of life but modest benefits in psychological and general health measures. More comparative studies on functional status and quality of life are needed for informed treatment decision making.

SUBMITTER: Kim CA

PROVIDER: S-EPMC4039034 | biostudies-literature | 2014 Feb

REPOSITORIES: biostudies-literature

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Functional status and quality of life after transcatheter aortic valve replacement: a systematic review.

Kim Caroline A CA Rasania Suraj P SP Afilalo Jonathan J Popma Jeffrey J JJ Lipsitz Lewis A LA Kim Dae Hyun DH

Annals of internal medicine 20140201 4

<h4>Background</h4>The functional and quality-of-life benefits of transcatheter aortic valve replacement (TAVR) have not been established.<h4>Purpose</h4>To evaluate the changes in functional status and quality of life after TAVR.<h4>Data sources</h4>MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from 1 January 2002 to 30 September 2013.<h4>Study selection</h4>Studies of TAVR that reported the New York Heart Association (NYHA) class, Short Form-12/36 Health Survey physic ...[more]

PMID: 24727842

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Project description:BackgroundTo compare functional and health related quality of life outcomes post-transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in patients with critical aortic stenosis (AS) across low to high-risk surgical candidates. These patient-centred factors will be compared between both groups in the short to medium term time frames and will aid in shared decision making between patients and healthcare workers.Materials and methodsWe conducted a systematic review and meta-analysis of randomised controlled trials which compared TAVI with SAVR and reported on quality of life (QoL) and functional scores. The scores used were the Kansas City Cardiomyopathy Questionnaire (KCCQ), Euroqol-5DL (EQ5DL), the short form-36/12 (SF-36/12) and the NYHA.ResultsWe identified eight trials with a total of 8898 participants. Both groups showed improvements from baseline at one month. At one month there was a statistically significant difference in standardised mean difference (SMD) in favour of TAVI for EQ5DL (SMD 0.37, 95% CI 0.26,0.49), KCCQ (SMD 0.53,95% CI 0.48, 0.58), SF physical summary (SMD 0.55, 95% CI 0.31 - 0.78) and SF mental summary (SMD 0.34, 95% CI 0.27 - 0.40). At one year there was no statistically significant difference between any of these QoL metrics. For NYHA, no significant difference in odds ratio of class III/IV was observed at one month between TAVI and SAVR (OR 0.94, 95% CI 0.83, 1.07), however, TAVI was associated with reduced odds ratio of NYHA class I/II at one year (OR 0.87, 95% CI 0.78, 0.98).ConclusionBoth groups were associated with improvements in QoL and functional outcomes with TAVI reporting more significant improvements in QoL at one-month post-procedures. No significant improvements between groups were seen at one year. This is the largest meta-analysis comparing post-operative health-related quality of life outcomes post SAVR and TAVI and has major implications in shared decision making for the treatment of aortic stenosis.

Dataset Information

Functional status and quality of life after transcatheter aortic valve replacement: a systematic review.

Publications

Functional status and quality of life after transcatheter aortic valve replacement: a systematic review.

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