STS/ACC TVT Registry: Patient-Reported vs. Physician-Estimated Symptoms in TAVR

Physicians do a poor job of estimating symptoms and functional status in patients with severe aortic stenosis undergoing TAVR, emphasizing the importance of collecting patient-reported health status, according to a study published Oct. 30 in the European Heart Journal: Quality of Care & Clinical Outcomes.

Suzanne V. Arnold, MD, MHA, FACC, et al., used data from the STS/ACC TVT Registry to determine the concordance between physician-assessed NYHA class and patient-reported health status on the Kansas City Cardiomyopathy Questionnaire (KCCQ) in 172,667 patients undergoing transfemoral TAVR. Participants had NYHA and KCCQ data collected both before and 30 days after their procedure. The investigators also looked at predictors of physician under- and overestimation of symptoms. The KCCQ Overall Summary score (KCCQ-OS) was categorized as 0-44, 45-59, 60-74 and 75-100, roughly corresponding to NYHA class IV, III, II and I, respectively.

The study cohort had a median age of 81 years, 45% were women, 9.1% had severe lung disease and the median STS Predicted Risk of Mortality (PROM) score was 4.8%. Patients had a median KCCQ-OS score of 45.8 and 60.5% were estimated to be NYHA Class III at the beginning of the study. At baseline, physicians underestimated symptoms in 47.4% of patients, correctly assessed symptoms in 26.6% and overestimated symptoms in 26%. At 30 days after TAVR, physicians underestimated symptoms in 22.8% of patients, correctly assessed them in 50.3% and overestimated symptoms in 26.9%.

Before TAVR, the clinicians were more likely to underestimate symptoms among patients who were female, as well as those a higher body mass index, history of stroke, severe lung disease or atrial fibrillation (AFib). After the procedure, characteristics associated with both under- and overestimation of symptoms included older age, female sex, prior stroke, lung disease, AFib, higher body mass index and higher STS-PROM scores. Physicians were more likely to incorrectly estimate patients’ symptoms among women and those with prior stroke, severe lung disease, AFib or obesity.

 According to the authors, the findings underscore the need for registries and clinical trials to collect patient-reported health status and should support efforts increase clinical use of KCCQ before and after TAVR. “This misestimation of patients’ symptoms and functional limitations could have implications for both quality reporting/risk standardization as well as patient care,” they write.

Keywords: STS/ACC TVT Registry, National Cardiovascular Data Registries, Cardiomyopathies, Physicians, Obesity, Lung Diseases, Stroke, Registries, Aortic Valve Stenosis, Transcatheter Aortic Valve Replacement, Atrial Fibrillation


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