Patient-defined Outcomes in Cardiovascular Surgery and Interventions

Area of Science:

• Cardiovascular Medicine
• Patient-Centered Care
• Health Outcomes Research

Background:

• Traditional cardiovascular care success metrics, like mortality rates, are insufficient for aging populations undergoing complex procedures.
• Patient-reported outcomes (PROs) capture quality of life but are often clinician-framed, lengthy, and hard to integrate into routine clinical practice.

Purpose of the Study:

• To introduce and define patient-defined outcomes (PDOs) as a patient-led evolution of PROs.
• To highlight PDOs' focus on patient priorities such as autonomy, independence, and avoiding undesirable outcomes.
• To propose PDOs as interpretable, autonomy-centered endpoints for cardiovascular care.

Main Methods:

• Development of composite PDOs, including disability-free survival and patient-defined adverse events, in collaboration with patients.
• Conceptual framework contrasting PDOs with traditional mortality benchmarks and clinician-framed PROs.
• Emphasis on integrating PDOs into preoperative assessment and optimization within cardiac surgical and interventional workflows.

Main Results:

• PDOs offer a patient-centered alternative to traditional outcomes, emphasizing quality of life beyond survival.
• Disability-free survival and patient-defined adverse events are examples of actionable PDOs.
• PDOs are interpretable and autonomy-centered, unlike potentially unwieldy PRO questionnaires.

Conclusions:

• Patient-defined outcomes represent a paradigm shift in evaluating cardiovascular care success.
• Integrating PDOs into perioperative workflows aligns medical interventions with individual patient goals and values.
• PDOs have the potential to transform cardiovascular care by prioritizing patient well-being and improving quality of life.