Does Transcatheter Aortic Valve Replacement Performed in a Community Hospital Setting Improve Health Related Quality of Life?
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Problem. The efficacy of Transcatheter Aortic Valve Replacement (TAVR) for aortic stenosis (AS) has been established in multicenter randomized controlled trials, but its effectiveness in community hospital settings is less certain. Objective. To improve our understanding of the Health Related Quality of Life (HRQOL) benefits of TAVR in a community hospital setting. Background literature/Theoretical framework. Despite the overall success of TAVR approximately one-third of patients have disappointing HRQOL outcomes, as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ). Methods. A one-group observational study of TAVR patients treated at St. Peter’s Hospital (Albany, NY) was done. To assess possible HRQOL benefits, preoperative, 1-month postoperative, and 1-year postoperative mean KCCQ scores were compared using repeated measures ANOVA. Bivariate correlations between preoperative mortality risk scores and the KCCQ scores were done. To control for confounding factors in this relationship, multiple linear regressions of KCCQ against six independent variables were also done. Results. From 2013 to 2017, 188 patients underwent TAVR at St. Peter’s Hospital. Preoperative, 1-month, and 1-year postoperative mean KCCQ scores were 41.6, 67.8, and 89.1 respectively. This improvement was significant in ANOVA (p<0.001). Preoperative and 1- month postoperative KCCQ scores were negatively and significantly correlated with preoperative mortality scores (r = -0.27, p = 0.001, r = -0.16, p = 0.035). In regression models, mortality risk score was not a significant predictor of KCCQ scores. Conclusions and Implications. Patients undergoing TAVR in a community hospital setting (St. Peter’s Hospital) experienced a significant improvement in HRQOL.