Functional Status and Quality of Life After Transcatheter Aortic Valve Replacement
- 18 February 2014
- journal article
- review article
- Published by American College of Physicians in Annals of Internal Medicine
- Vol. 160 (4), 243-254
- https://doi.org/10.7326/M13-1316
Abstract
This article has been corrected. The original version (PDF) is appended to this article as a Supplement. The functional and quality-of-life benefits of transcatheter aortic valve replacement (TAVR) have not been established. To evaluate the changes in functional status and quality of life after TAVR. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from 1 January 2002 to 30 September 2013. 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. 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. We identified 60 observational studies (56 pre–post comparison and 4 head-to-head comparative studies) and 2 randomized, controlled trials (11 205 patients). Most studies showed a clinically important decrease in NYHA class at 6 to 11 months (range, −0.8 to −2.1 classes) and 12 to 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 to 26.9 points), and the change in mental component score was smaller (range, 1.0 to 8.9 points). Clinically important improvements were seen in other disease-specific measures but were less consistently seen in general health measures. Comparative evidence is limited by few head-to-head studies. Survivor bias may have overestimated the benefits. Transcatheter aortic valve replacement provides clinically important benefits in physical function and disease-specific measures of quality of life but modest benefits in psychological and general health measures. More comparative studies on functional status and quality of life are needed for informed treatment decision making. Health Resources and Services Administration and Health Resources in Action.Keywords
This publication has 102 references indexed in Scilit:
- Relation Between Six-Minute Walk Test Performance and Outcomes After Transcatheter Aortic Valve Implantation (from the PARTNER Trial)The American Journal of Cardiology, 2013
- Early and intermediate survival after transcatheter aortic valve implantation: systematic review and meta-analysis of 14 studiesBMJ Open, 2013
- Quality of life among patients with severe aortic stenosisNetherlands Heart Journal, 2012
- Morbidity and mortality of nonagenarians undergoing CoreValve implantationBMC Cardiovascular Disorders, 2012
- Quality of life improvement is maintained up to two years after transcatheter aortic valve implantation in high-risk surgical candidatesEuroIntervention, 2012
- The risk-to-benefit ratio of transcatheter aortic valve implantation in specific patient cohorts: a single-centre experienceClinical Research in Cardiology, 2012
- Comprehensive assessment of frailty for elderly high-risk patients undergoing cardiac surgery☆European Journal of Cardio-Thoracic Surgery, 2011
- One year follow-up of the multi-centre European PARTNER transcatheter heart valve studyEuropean Heart Journal, 2010
- Limitations of the New York Heart Association functional classification system and self-reported walking distances in chronic heart failureHeart, 2007
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986