The acceptability of heart valve replacement procedures, and patient-reported outcomes in adults with aortic stenosis

Abstract

The incidence of aortic stenosis (AS) is high and increasing alongside the aging of populations in developed countries. Yet the impact of severe AS and associated treatments on the lives of people and their carers who provide support, is poorly understood.

This thesis aims to investigate patient-reported outcomes of severe AS and valve replacement for adults living with AS and the acceptability of these replacement procedures for individuals and their carers.

A multi-method study was conducted, consisting of two systematic reviews one of which synthesised the evidence for functional capacity and health-related quality of life (HRQoL) outcomes after transcatheter aortic valve replacement (TAVR), and another determining the validity and reliability of consumer-grade wearables to monitor physical activity in older, community-dwelling adults. Additionally, a study (n=32) measuring AS patients' functional capacity, physical activity and HRQoL before and after AVR and a descriptive, qualitative study exploring the acceptability of TAVR to patients (n=18) and their carers (n=8) were conducted.

Before valve replacement severe AS patients had poor functional capacity, physical activity and HRQoL. Evidence from the reviews and the study demonstrated that for most people with severe AS, AVR by any mode improves functional capacity and overall HRQoL and that wearable activity trackers can accurately measure physical activity amongst older adults. AS patients and their carers found TAVR to be an acceptable intervention to treat the condition, addressing pre-operative symptom-driven emotions of struggling and fear, and fostering post-operative feelings of confidence and an ability to get back to a sense of normal. Furthermore, TAVR aligned with participants’ values, preferences and needs. Understanding the impact of severe AS on the lives of patients and their carers will enable clinicians to tailor clinical support before and after treatment.