P2519: The Impact of Transcatheter Aortic Valve Implantation on Quality of Life: A Mixed Methods Study

Objective: To provide an in-depth understanding of patients' views about the impact of transcatheter aortic valve implantation on self-reported quality of life. Background: Transcatheter aortic valve implantation is considered to be the gold standard of care for inoperable patients diagnosed with severe symptomatic aortic stenosis. Mid- to long-term clinical outcomes are favourable and questionnaire data indicates improvements in quality of life but an in-depth understanding of how quality of life is altered by the intervention is missing. Methods: A mixed methods study design with a total of 89 in-depth qualitative interviews conducted with participants (39% male; mean age 81.7 years), 1 and 3 months post TAVI, recruited from a regional centre in England. Data were triangulated with questionnaire data (SF-36 and EQ5D-VAS) collected, pre, 1 and 3 months post implantation. Results: Participants' accounts were characterised by four key themes; shortened life, extended life, limited life and changed life. Quality of life was changed through two mechanisms. Most participants reported a reduced symptom burden and all explained that their life expectancy was improved. Questionnaire data supported interview data with gradual improvements in mean EQ-5D scores and SF-36 physical and mental domain scores at 1 and 3 months compared to baseline. Conclusion: Findings suggest that TAVI was of variable benefit, producing considerable improvements in either mental or physical health in many participants, while a smaller proportion continued to deteriorate

Double valve replacement for acute spontaneous left chordal rupture secondary to chronic aortic incompetence

A 54 years old male with undiagnosed chronic calcific degenerative aortic valve incompetence presented with acute left anterior chordae tendinae rupture resulting in severe left heart failure and cardiogenic shock. He was successfully treated with emergency double valve replacement using mechanical valves. The pathogenesis of acute rupture of the anterior chordae tendinae, without any evidence of infective endocarditis or ischemic heart disease seems to have been attrition of the subvalvular mitral apparatus by the chronic regurgitant jet of aortic incompetence with chronic volume overload. We review the literature with specific focus on the occurrence of this unusual event

The experience of primary PCI: A patients' perspectives

Background Primary Percutaneous Coronary Intervention (p-PCI) is recognized as the gold standard treatment for patients with STEMI. Little is known about patients' experiences of p-PCI and the way in which events that occur during hospitalization might influence ways in which they ‘make sense’ of their illness during recovery. Previous Section Next Section Purpose To explore patients' experiences of p-PCI and the way they ‘make sense’ of events. Previous Section Next Section Methods Mixed methods were used (Semi-structured interviews and Illness Perception Questionnaire—Revised version, (IPQ-R) Moss-Morris et al. 2002) and a purposive sample of 29 patients recruited from a specialist UK cardiac centre serving a population of over 2 million. The average age of participants was 60 years (range 36–83), 59% were male and 14% lived alone. Interviews were conducted 3–12 days after primary PCI. All participants were fluent in English, had no documented cognitive deficits or prior cardiac history. One-to-one interviews were audio-taped and transcribed verbatim. NVivo software was used in conjunction with Framework Analysis techniques to systematically order and synthesize findings. As part of this method, a priori issues and available literature were integrated into the data analysis. A thematic framework to guide analysis was reached by consensus with a researcher not involved in the interview process and subsequently applied to all the transcripts. Scores from the IPQ-R were used to illuminate and inform qualitative data. Previous Section Next Section Result Patients often experienced a mismatch between their expectations and reality. They often expected to have a general anesthetic and more procedural pain. The lack of a scar and unexpected feelings of energy was incongruent with the seriousness of their condition. Quantitative data supported the notion that patients experienced difficulty in ‘making sense’ of their condition. They tended to see their condition as ‘acute’ rather than ‘chronic’ and their treatment as curative. Previous Section Conclusions Collaborative discussions between patients and health professional about their interpretations of their p-PCI experience may promote a more coherent understandin

The information needs of patients treated with primary angioplasty for heart attack: an exploratory study.

As early recovery is a challenging period for cardiac patients who frequently have 'unmet' health information needs, the objective of this study was to explore the information needs of patients treated with primary angioplasty for heart attack