Implementing Shared Decision-Making for Patients with Aortic Valve - - PowerPoint PPT Presentation

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Implementing Shared Decision-Making for Patients with Aortic Valve - - PowerPoint PPT Presentation

Nov 16, 2022 207 likes •336 views

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

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ANNUAL MEETING

  • OCT. 31-NOV. 2, 2017

ARLINGTON, VA

#PCORI2017

Implementing Shared Decision-Making for Patients with Aortic Valve Disease

  • J. Matthew Brennan, MD MPH

Interventional Cardiology Duke Triangle Heart Associates Associate Professor of Medicine Duke University School of Medicine November 1, 2017

Susan Strong

Patient Representative Denver, CO

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ANNUAL MEETING | #PCORI2017

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Overview

  • Patient’s Perspective: Personalizing the Treatment of

Aortic Valve Disease

  • PCORI ADVICE Study: Developing Decision Aids for

Aortic Valve Disease

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ANNUAL MEETING | #PCORI2017

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Aortic Valve Disease: What are the treatment

  • ptions?

Surgical Valve Replacement (SAVR)

Transcatheter Valve Replacement (TAVR)

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ANNUAL MEETING | #PCORI2017

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The Counterfactual

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ANNUAL MEETING | #PCORI2017

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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
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ANNUAL MEETING | #PCORI2017

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Clinical Equipoise

No TAVR

  • Age <65 yrs
  • Endocarditis
  • Emergency/Salvage
  • Aortic Insufficiency

without stenosis

  • Moderate/Severe

Mitral Stenosis

  • Low risk for SAVR (STS

PROM <3%) No SAVR

  • Age >90 yrs
  • Hostile chest

Other

  • Centers with <10 TAVR

cases

Exclusions:

Spectrum of Patient Risk

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ANNUAL MEETING | #PCORI2017

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Assessing Balance

HR 1.45 (1.04-2.02) p=0.028

SAVR TAVR

Measured Confounders

Propensity Matching

Unmeasured Confounders

Falsification Outcome (UTI)

(Nov 2011 – June 2014)

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ANNUAL MEETING | #PCORI2017

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Urinary Tract Infection SAVR TAVR

Assessing Balance

(Jan 2014 – Q3 2015)

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ANNUAL MEETING | #PCORI2017

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PCORI ADVICE Study: Risk Models (SAVR vs TAVR)

5 Clinical Outcomes 1. Discharge to home 2. Death, 1 year 3. Stroke, 1 year 4. Days alive and out of hospital, 1st year 5. Alive and better, 1 year Model Parameters

  • Demographics
  • Medical History
  • Labs
  • Testing
  • Clinical Status

Mortality – 1 year Stroke – 1 year “Alive and Better”

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ANNUAL MEETING | #PCORI2017

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PCORI ADVICE Study: Decision Assistance Tool

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ANNUAL MEETING | #PCORI2017

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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