Health-Related Quality of Life After Transcatheter Aortic Valve Replacement in Inoperable Patients With Severe Aortic Stenosis
What are the effects of transcatheter aortic valve replacement (TAVR) on health-related quality of life?
The Placement of Aortic Transcatheter Valves (PARTNER) trial randomized patients with symptomatic, severe aortic stenosis who were not candidates for surgical valve replacement to TAVR (n = 179) or standard therapy (n = 179). Health-related quality of life was assessed at baseline and at 1, 6, and 12 months with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the 12-item Short Form-12 General Health Survey (SF-12). The primary endpoint was the KCCQ overall summary score (range, 0-100; higher = better).
At baseline, mean KCCQ summary scores (35 ± 20) and SF-12 physical summary scores (28 ± 7) were markedly depressed. Although the KCCQ summary score improved from baseline in both groups, the extent of improvement was greater after TAVR compared with control at 1 month (mean between-group difference, 13 points; 95% confidence interval, 8-19; p < 0.001) with larger benefits at 6 months (mean difference, 21 points; 95% confidence interval, 15-27; p < 0.001) and 12 months (mean difference, 26 points; 95% confidence interval, 19-33; p < 0.001). At 12 months, TAVR patients also reported higher SF-12 physical and mental health scores with mean differences compared with standard care of 5.7 and 6.4 points, respectively (p < 0.001 for both comparisons).
The authors concluded that among inoperable patients with severe aortic stenosis, compared with standard care, TAVR resulted in significant improvements in health-related quality of life that were maintained for at least 1 year.
This preplanned substudy of the PARTNER trial suggests that TAVR in addition to a large survival benefit also provides substantial benefits over standard therapy in terms of symptoms and health-related quality of life. These differences were seen as early as 1 month and continued to increase over the 12-month follow-up of the study. Taken together with previously reported benefits on both survival and rehospitalization, these findings support the consideration of TAVR as a viable therapeutic option for patients with severe aortic stenosis who are not candidates for aortic valve replacement surgery.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention
Keywords: Heart Valve Prosthesis, Health Status Indicators, Standard of Care, Heart Valve Prosthesis Implantation, Health Surveys, Surgical Instruments, Kansas, Quality of Life, Cardiovascular Diseases, Confidence Intervals, Octamer Transcription Factor-3, Mental Health
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