As the option of TAVR expands to low-risk patients, a shared decision-making approach may be the best option for all patients considering aortic valve replacement, according to a paper published March 9 in the Journal of the American College of Cardiology.

Megan Coylewright, MD, MPH, FACC, et al., highlight how advances in research and resultant policy changes regarding the treatment of aoristic stenosis (AS) are shaping clinician and patient decision-making. While the U.S. Food and Drug Administration approved TAVR in low-surgical-risk patients in August 2019, the authors note that direction is still lacking regarding the best practices for clinicians to guide these patients through the newly available choice of TAVR vs. SAVR.

The authors explain that shared decision-making, with use of decision aids, is widely seen as a measure of high-quality decision making and is increasingly recommended in expert consensus statements and reimbursed by payers. Although heart team clinicians often feel they already use a shared decision-making approach, research suggests that basic patient education is often confused with this process.

The authors note that it is incumbent on the cardiology and cardiac surgery communities to embrace the existing evidence demonstrating that shared decision-making is limited in real-world practice, and identify tools and implementation strategies to bring shared decision-making to patients with severe AS.

"Through this approach of positioning the patient as an expert in his or her own values, perspectives and goals, we can hope to experience improvements in the quality of care delivery and patient-centered outcomes seen in other areas of medicine and surgery with shared decision-making, and match the rapid innovation in therapeutic choices with state-of-the-art health care delivery," the authors conclude.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery

Keywords: Aortic Valve, Constriction, Pathologic, Transcatheter Aortic Valve Replacement, Delivery of Health Care, Patient-Centered Care, Quality of Health Care

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