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Presentation on US Hospital Websites of Risks and Benefits of Transcatheter Aortic Valve Replacement Procedures | Journal Scan
Study Questions:
What is the information regarding known risks and benefits of transcatheter aortic valve replacement (TAVR) made available to the public on the websites of US hospitals currently performing TAVR procedures?
Methods:
The authors reviewed the websites of all 317 hospitals listed in the Society of Thoracic Surgeons and the American College of Cardiology’s Transcatheter Valve Therapy Registry using common search engines. One of the authors reviewed each site for English-language pages mentioning TAVR and abstracted information into a standardized form regarding terms related to 11 potential risks and 11 potential benefits of TAVR compared with open aortic valve replacement that they defined a priori based on review of a major randomized trial. Fisher exact tests were calculated using Stata, version 12.0 (StataCorp LP), to determine statistical significance between certain categorical variables.
Results:
Nearly all the websites included in the analysis (260 [99.2%]) described at least one benefit of TAVR relative to open aortic valve replacement. The most common benefits mentioned were the lower degree of invasiveness of TAVR compared with open aortic valve procedures (mentioned in 250 websites [95.4%]), the potential for more rapid recovery (125 [47.7%]), the lack of requirement for cardiopulmonary bypass (120 [45.8%]), and improved quality of life (119 [45.4%]). Sixty-nine websites (26.3%) mentioned one or more risks of TAVR, which is significantly fewer than those mentioning benefits (p < 0.001). Risks listed on these websites included stroke or transient ischemic attack (mentioned on 48 websites [18.3%]), vascular complications (36 [13.7%]), death (31 [11.8%]), and unknown long-term valve durability (28 [10.7%]). Numerical quantitative information was provided more frequently for benefits than for risks (p < 0.001), with any benefit term quantified on 97 websites (37.0%), while any risk term was quantified on only 12 websites (4.6%).
Conclusions:
The authors concluded that although US hospital websites universally discuss the benefits of TAVR, they rarely present information on the potential risks of this procedure to the public.
Perspective:
This study reports that of the websites reviewed, 99.2% included information on specific benefits of TAVR, whereas only 26.3% presented any information on specific risks associated with this procedure. Moreover, while websites rarely presented quantitative information about either risks or benefits, benefits were quantified more frequently than risks. These findings suggest that web-based advertising of TAVR to the public by hospitals may potentially understate the established risks of this procedure and provide little context for the magnitude of those risks to inform patient decision making. Hospitals may promote appropriate use of TAVR by presenting more balanced information regarding TAVR’s risks and benefits to help patients make informed decisions.
Keywords: Aortic Valve, Cardiopulmonary Bypass, Decision Making, Ischemic Attack, Transient, Quality of Life, Registries, Risk, Risk Assessment, Search Engine, Stroke, Surgeons, Transcatheter Aortic Valve Replacement, United States
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