implementing shared decision making for patients with
play

ANNUAL OCT. 31-NOV. 2, 2017 MEETING ARLINGTON, VA Implementing Shared Decision-Making for Patients with Aortic Valve Disease Susan Strong J. Matthew Brennan, MD MPH Patient Representative Interventional Cardiology Denver, CO Duke

0 downloads 2 Views 837 KB Size Report
  1. ANNUAL OCT. 31-NOV. 2, 2017 MEETING ARLINGTON, VA Implementing Shared Decision-Making for Patients with Aortic Valve Disease Susan Strong J. Matthew Brennan, MD MPH Patient Representative Interventional Cardiology Denver, CO Duke Triangle Heart Associates Associate Professor of Medicine Duke University School of Medicine #PCORI2017 November 1, 2017

  2. ANNUAL MEETING | #PCORI2017 Overview • Patient’s Perspective: Personalizing the Treatment of Aortic Valve Disease • PCORI ADVICE Study: Developing Decision Aids for Aortic Valve Disease 2

  3. ANNUAL MEETING | #PCORI2017 Aortic Valve Disease: What are the treatment options? Surgical Valve Replacement Transcatheter Valve Replacement (SAVR) (TAVR) 3

  4. ANNUAL MEETING | #PCORI2017 The Counterfactual 4

  5. ANNUAL MEETING | #PCORI2017 PCORI ADVICE Study: Data Sources & Design • Procedural registry data - STS National Database - STS/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry • Follow-up: Medicare claims • Observational Study (non-randomized) • Propensity-matched cohort 5

  6. ANNUAL MEETING | #PCORI2017 Exclusions: Clinical Equipoise No TAVR • Age <65 yrs • Age >90 yrs • Endocarditis • Hostile chest • Emergency/Salvage • Aortic Insufficiency Other without stenosis • Centers with <10 TAVR • Moderate/Severe cases Mitral Stenosis • Low risk for SAVR (STS PROM <3%) No SAVR Spectrum of Patient Risk 6

  7. ANNUAL MEETING | #PCORI2017 Assessing Balance Measured Confounders Unmeasured Confounders Propensity Matching Falsification Outcome (UTI) HR 1.45 (1.04-2.02) p=0.028 SAVR TAVR (Nov 2011 – June 2014) 7

  8. ANNUAL MEETING | #PCORI2017 Assessing Balance Urinary Tract Infection SAVR TAVR (Jan 2014 – Q3 2015) 8

  9. ANNUAL MEETING | #PCORI2017 PCORI ADVICE Study: Risk Models (SAVR vs TAVR) 5 Clinical Outcomes Model Parameters 1. Discharge to home • Demographics 2. Death, 1 year • Medical History 3. Stroke, 1 year • Labs Days alive and out of hospital, 1 st year 4. • Testing 5. Alive and better, 1 year • Clinical Status Stroke – 1 year “Alive and Better” Mortality – 1 year 9

  10. ANNUAL MEETING | #PCORI2017 PCORI ADVICE Study: Decision Assistance Tool 10

  11. ANNUAL MEETING | #PCORI2017 Questions? J. Matthew Brennan, MD MPH Interventional Cardiology Duke Triangle Heart Associates Associate Professor of Medicine Duke University School of Medicine j.matthew.brennan@dm.duke.edu November 1, 2017 11

Recommend Documents


mi mi and shared mi mi and shared and shared decision
MI MI and Shared MI MI and Shared

The project PRECIOUS has received funding from the European Union s Seventh

implementing shared decision making with low health
Implementing Shared Decision Making

Implementing Shared Decision Making with Low Health Literacy Patients

shared decision making in the ed for patients with low
Shared Decision Making in the ED for

Shared Decision Making in the ED for Patients with Low-Risk Chest Pain: The

the share communication
THE SHARE COMMUNICATION FRAMEWORK

THE SHARE COMMUNICATION FRAMEWORK SUPPORTING PHYSICIANS IN SHARED

objectives
Objectives At the end of this workshop

Objectives At the end of this workshop you will: Understand the key

shared decision making connecting clinicians and patients
Shared Decision Making: Connecting

Shared Decision Making: Connecting Clinicians and Patients to Improve

shared decision making
Shared Decision-Making: Bringing

Shared Decision-Making: Bringing Patients into their Healthcare Loop Suresh

shared decision making for bariatric surgery in patients
Shared Decision Making for Bariatric

Shared Decision Making for Bariatric Surgery in Patients with Severe Obesity

when we talk about patient engagement and shared decision
When we talk about patient engagement

When we talk about patient engagement and shared decision-making there are a

shared decision making workgroup
Shared Decision Making Workgroup

Shared Decision Making Workgroup January 25 th , 2019 Agenda Welcome and

tasq development of a scale based on a
(TASQ): Development of a Scale Based on

Toronto Aortic Stenosis Quality of Life Scale (TASQ): Development of a Scale

overview of the data center
Overview of the Data Center William M.

Overview of the Data Center William M. DeCampli MD, PhD Congenital Heart

ecmo in the emergency department
ECMO. In the Emergency Department

ECMO. In the Emergency Department John C. Greenwood, MD Department of

tirone david v s mod v sarr for
Tirone David-V S mod V-SARR for

Tirone David-V S mod V-SARR for Bicuspid Aortic Valve (BAV) Aortopathy and AR

late presentation of turner syndrome and its
Late Presentation of Turner Syndrome

Late Presentation of Turner Syndrome and Its Complications Huzairi Sani 1 ,

improving the efficiency of manual ground truth labeling
Improving the Efficiency of Manual

Improving the Efficiency of Manual Ground Truth Labeling Using Automated

atrioventricular block as the initial presentation of
Atrioventricular block as the initial

See discussions, stats, and author profiles for this publication at:

for isolated aortic valves replacement
for Isolated Aortic Valves Replacement

A Multistate Analysis of the Readmission Rates for Isolated Aortic Valves

clinical trial in patients with transthyretin amyloid
Clinical Trial in Patients with

Safety, Tolerability and Transthyretin Stabilization by AG10: A Phase 2,

pharm acovigilance
Pharm acovigilance Joint plenary of

Pharm acovigilance Joint plenary of PCWP and HCPWP: September 2019 Dr Peter

specialist collaborative models
Specialist Collaborative Models RGPs

Optimizing Outcomes For Frail High Risk Seniors Through Specialist-Specialist

deep learning framework
DEEP LEARNING FRAMEWORK FOR

DEEP LEARNING FRAMEWORK FOR DIAGNOSTICS AND PATIENT-SPECIFIC DESIGN OF