Health-related quality of life (HRQoL) is a multi-dimensional concept that includes domains related to physical, mental, emotional, and social functioning. Kansas City Cardiomyopathy Questionnaire (KCCQ) is typically utilized to assess the HRQoL after TAVR

Running Head: Patient satisfaction questionnaire after TAVR

HRQoL: Health-related quality of life

IQR: Interquartile range

KCCQ: Kansas City Cardiomyopathy Questionnaire

SD: Standard deviation

TAVR: Transcatheter aortic valve replacement

Health-related quality of life (HRQoL) is a multi-dimensional concept that includes domains related to physical, mental, emotional, and social functioning. Kansas City Cardiomyopathy Questionnaire (KCCQ) is typically utilized to assess the HRQoL after TAVR [1]. In our experience, this questionnaire is rather difficult for elderly patients to comprehend and respond to. In addition, we feel that the patient satisfaction represents the perception of HRQoL in patient’s life and may be more appropriate at gauging health-related benefits post-TAVR. The aims of this study were to correlate the patient satisfaction questionnaire with the current KCCQ among patients undergoing TAVR and to evaluate change in satisfaction post TAVR (1 week to 1 month).

All patients undergoing TAVR that survived to hospital discharge were prospectively enrolled in this study after obtaining informed consent. The satisfaction questionnaire (Figure 1) was administered at 1-week (range 7-10 days) and 1-month after TAVR (range 28-36 days). The satisfaction questionnaire consisted of seven simple questions with simple responses. 

Figure 1: The satisfaction questionnaire post TAVR consisted of seven simple questions with simple responses.

The total score could range from 7 to 33, with higher scores indicating higher satisfaction. The total score on the questionnaire was calculated by adding the points from each question. We included a categorical question, specific to TAVR – “Would you have this TAVR procedure again?”

A total of 118 patients, including 63 males and 55 females, were included between May 2018 and June 2019. Mean (SD) age was 82.1 [8.4] years. Edwards Sapien S3 valve was used in 88 patients, while Medtronic CoreValve was used in 30 patients. Of all patients, 95 patients completed the survey at both 1-week and 1-month follow-up. At 1-week, the proportion of patients indicating that they would definitely have TAVR again was 49.5%, which increased to 68.4% at 1-month follow up (p<0.001). Median (IQR) total satisfaction score increased from 24 [22-26] at 1-week to 26 [24-29)] at 1-month (p<0.001 using Wilcoxon sign rank test). Using pairwise correlation, we observed a moderate degree of correlation between 1-month satisfaction scores and the 1-month KCCQ scores in our cohort (correlation coefficient: 0.51, p<0.001) (Figure 2).

Figure 2: Pairwise correlation between 1-month satisfaction scores and the 1-month KCCQ scores in our cohort (correlation coefficient: 0.51, p<0.001).

n this prospective study, we assessed a simple 7-question survey specifically for elderly patients undergoing TAVR at a moderate volume referral center. Based on our experience with the KCCQ, we have realized a need for a simple questionnaire to assess satisfaction consistently in this population. One can surmise that HRQoL assessed using KCCQ may not be completely applicable to the TAVR cohort due to intrinsic differences between the heart failure patients and the TAVR patients. This was evident with only a moderate degree of correlation observed between the two scoring systems. Even though the correlation existed and was statistically significant in a positive direction, it was moderate at best. Despite this, majority of the patients have enough benefit to consider TAVR worthwhile. According to a meta-analysis of 20 studies, functional capacity as well as HRQoL improved substantially following TAVR, despite evolution in patient selection criteria over time [2]. In addition, there was a continued improvement in patient satisfaction noted from one week to one month after that TAVR procedure. According to the Transcatheter Valve Therapy (TVT) registry, 38.9% of patients after TAVR between 2011-2015 had “poor outcome” defined as death, poor HRQoL or decline in HRQoL [3]. The outcomes have improved over time likely because of improvement in patient selection, device technology and operator experience and advancement in peri-procedural care [3]. Our study had important limitations to consider. The number of patients in our study was relatively small though we included all the patients during the study period. Additionally, there were only 7 questions in the questionnaire, which might not be able to explore all domain of quality of life. However, our questionnaire was designed to be simple and easy to understand for elderly patients. Lastly, we didn’t include other HRQoL questionnaires such as EuroQoL-5 Dimension and 36-Item Short Form Survey in our study.

In conclusion, in this prospective study from a referral TAVR center, we have assessed a simple 7-question survey evaluating patient satisfaction at 1-week and 1-month after TAVR, which may be applicable to a wide variety of settings nationally and internationally.