April 21st, 2014
The CoreValve Trial: What Do You Say to Your Patients?
This post from CardioExchange Editor Harlan Krumholz asks: How do you communicate with your patients about cutting-edge research findings that are very complex or controversial? Your patients may have questions about the latest guideline or study that they hear about on the news. How do you interpret the nuances of the findings and explain how they may — or may not — apply to their care? If this blog generates valuable discussion, it may be the start of a new series on communicating with your patients about the latest research.
The CoreValve High Risk Study reported that, of 795 patients with severe aortic stenosis who were at increased surgical risk, those who were randomized to have transcatheter aortic-valve replacement (TAVR) with a self-expanding transcatheter aortic-valve bioprosthesis had a significantly higher survival at one year than did those randomized to have surgery. However, the finding was marginally significant and Sanjay Kaul suggested that a couple of extra deaths would have eliminated the finding. Also, the mortality difference did not appear until after two months of follow-up, which also raises a question of what might have accounted for the difference.
A patient comes to see you for a consultation. She is scheduled for surgical AVR with an experienced surgeon — and her clinical profile is identical to that of the patients involved in the CoreValve trial. She asks you if she can expect to live longer if she has TAVR instead of surgery.
The patient is bright but not a medical person.
What do you say to your patient?