Cardiologist, General Practitioner, Interventional Cardiologist

Understanding Patient Preferences in Heart Valve Disease Treatment

Understanding Patient Preferences in Heart Valve Disease Treatment

Heart valve disease (HVD) is a significant health issue in Australia, affecting an estimated 500,000–600,000 people in 2021, with approximately 254,000 individuals living with undiagnosed HVD. Common types of HVD include aortic stenosis (AS), mitral valve regurgitation, and tricuspid valve regurgitation. AS is the most prevalent in Australia, affecting 1 in 8 people over 65 years of age. Treatment options for HVD have evolved from traditional surgical methods to less invasive procedures like transcatheter aortic valve implantation (TAVI), which offer faster recovery and fewer complications.

A recent study aimed to understand patient preferences for HVD treatments in Australian and Japanese populations. This research is critical for enhancing shared decision-making between healthcare providers and patients, ensuring treatment plans align with patient goals and values.

Methods

The study employed a discrete choice experiment (DCE) to assess the treatment preferences of patients diagnosed with AS, mitral valve regurgitation, or tricuspid valve regurgitation. Participants were recruited from Australia and Japan and included those with varying experiences with heart valve procedures. The survey included demographic questions, disease history, quality of life assessments, and a DCE that presented participants with hypothetical treatment scenarios.

Key Findings

Treatment Preferences

  • Minimally Invasive Procedures: There was a strong overall preference for minimally invasive procedures, particularly TAVI, among patients in both countries. This preference was consistent regardless of previous treatment experience.
  • Valve Durability and Independence: The most critical attributes influencing patient choices were valve durability and the likelihood of regaining independence one month after the procedure. Australian patients placed greater emphasis on valve durability, while Japanese patients valued independence more highly.
  • Risk Factors: Both Australian and Japanese patients preferred treatments with lower risks of mortality, stroke, dialysis, and the need for a new pacemaker.
  • Cost Considerations: Australian participants were more sensitive to the cost of procedures compared to their Japanese counterparts.

Predicted Treatment Uptake

  • Procedure Experience Effect: Patients were more likely to choose the type of procedure they had previously undergone. However, the preference for TAVI was so strong that it often reversed this effect, with patients favouring the minimally invasive option even if they had prior experience with invasive procedures.
  • Cultural Differences: Australian patients without prior procedure experience were more likely to choose minimally invasive procedures compared to their Japanese counterparts, who were roughly evenly split in their preferences.

Implications for Practice

These findings underscore the importance of considering patient preferences in the management of HVD. Shared decision-making should integrate patients' values, particularly regarding procedure invasiveness, recovery expectations, and associated risks. For general practitioners and cardiologists, understanding these preferences can improve patient satisfaction and treatment adherence.

Conclusion

The study highlights a clear preference among HVD patients for minimally invasive procedures, with significant emphasis on valve durability and post-procedure independence. These insights can guide healthcare professionals in Australia and Japan in tailoring treatment plans to better meet patient needs and preferences, ultimately enhancing the quality of care for those living with heart valve disease.

By prioritising patient-centred care and integrating these preferences into clinical practice, healthcare providers can improve outcomes and patient satisfaction in the treatment of heart valve disease.