Functional Status and Quality of Life After Transcatheter Aortic Valve Replacement: A Systematic Review
What are the changes in functional status and quality of life after transcatheter aortic valve replacement (TAVR)?
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 were selected for review. 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.
The investigators identified 60 observational studies (56 pre–post comparison and four head-to-head comparative studies) and two randomized, controlled trials (11,205 patients). Most studies showed a clinically important decrease in NYHA class at 6-11 months (range, −0.8 to −2.1 classes) and 12-23 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, 4.9-26.9 points), and the change in mental component score was smaller (range, 1.0-8.9 points). Clinically important improvements were seen in other disease-specific measures, but were less consistently seen in general health measures.
The authors concluded that TAVR provides clinically important benefits in physical function and disease-specific measures of quality of life, but modest benefits in psychological and general health measures.
This systematic review shows considerable variation across studies in the clinical characteristics of patients having TAVR and in the amount of improvement in functional outcomes and quality of life after TAVR. There was an overall trend that TAVR improved symptoms, physical function, and disease-specific measures of quality of life. However, the benefits in psychological dimension and general health measures were often small and inconsistent. This is important and relevant information for older patients with symptomatic severe AS whose goal may be to improve the quality of life and maintain functional independence rather than prolong the remaining life expectancy. Future research should address the heterogeneity of treatment effectiveness for better patient selection by incorporating individual frailty status and vulnerability to treatment-related adverse effects.
Clinical Topics: Cardiac Surgery
Keywords: Heart Valve Prosthesis, Quality of Life, Life Expectancy, New York, Treatment Outcome, Health Surveys
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