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Cardiologist and cardiac surgeon view on decision-making in prosthetic aortic valve selection: does profession
N M Korteland1, J Kluin, R J M Klautz
1Department of Cardiothoracic Surgery, Erasmus MC, Bd563, PO Box 2040, 3000CA, Rotterdam, the Netherlands.
Insights
Dutch cardiologists and surgeons value patient involvement in aortic valve selection. However, preferences for mechanical versus bioprosthetic valves and decision-making roles vary between these specialists.
Area of Science:
- Cardiovascular Medicine
- Surgical Innovation
- Patient-Centered Care
Background:
- Shared decision-making is crucial in complex medical choices.
- Aortic valve replacement involves significant patient and physician considerations.
- Understanding specialist perspectives is key to optimizing patient care.
Purpose of the Study:
- To compare Dutch cardiothoracic surgeons' and cardiologists' views on patient involvement in aortic valve selection.
- To assess how risks are communicated regarding aortic valve choices.
- To identify preferences for specific aortic valve prostheses between these specialties.
Main Methods:
- A survey was administered to 117 cardiothoracic surgeons and cardiologists.
- Responses were analyzed and compared using the Mann-Whitney U test.
- Data focused on opinions regarding patient involvement, risk communication, and valve preferences.
Main Results:
- A majority of respondents favored patient involvement in decision-making, with surgeons showing a stronger preference.
- Cardiologists leaned towards leading the decision-making process more than surgeons.
- Significant variation in aortic valve preference was observed, with cardiologists favoring mechanical and surgeons favoring bioprosthetic valves.
Conclusions:
- Both cardiologists and surgeons recognize the importance of patient involvement and risk communication in aortic valve selection.
- Specialty influences attitudes towards shared decision-making and prosthesis choice.
- The diversity in valve preferences suggests suitability of both types for many patients, highlighting the need for evidence-based shared decision-making.
Aims:
Assess and compare among Dutch cardiothoracic surgeons and cardiologists: opinion on (1) patient involvement, (2) conveying risk in aortic valve selection, and (3) aortic valve preferences.
Methods And Results:
A survey among 117 cardiothoracic surgeons and cardiologists was conducted. Group responses were compared using the Mann-Whitney U test. Most respondents agreed that patients should be involved in decision-making, with surgeons leaning more toward patient involvement (always: 83 % versus 50 % respectively; p < 0.01) than cardiologists. Most respondents found that ideally doctors and patients should decide together, with cardiologists leaning more toward taking the lead compared with surgeons (p < 0.01). Major risks of the therapeutic options were usually discussed with patients, and less common complications to a lesser extent. A wide variation in valve preference was noted with cardiologists leaning more toward mechanical prostheses, while surgeons more often preferred bioprostheses (p < 0.05).
Conclusion:
Patient involvement and conveying risk in aortic valve selection is considered important by cardiologists and cardiothoracic surgeons. The medical profession influences attitude with regard to aortic valve selection and patient involvement, and preference for a valve substitute. The variation in valve preference suggests that in most patients both valve types are suitable and aortic valve selection may benefit from evidence-based informed shared decision-making.
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