Pushing to keep going, scared: a qualitative study exploring why transcatheter aortic valve implantation to treat aortic stenosis is a highly acceptable intervention to patients and carers.

Type of funding sources: None.

Contemporary options to treat severe, symptomatic aortic stenosis (AS) include transcatheter and surgical approaches (TAVI and SAVR). Evidence continues to accumulate for minimally invasive TAVI to be used to treat AS for expanding patient groups, however patients experiences are seldom investigated.

The aim of this study was to explore patients and carers perspectives of the acceptability of TAVI as a treatment option for AS, in the context of their values, attitudes, and the burden and effectiveness of intervention, to better guide expectations and management of recovery.

Older patients (n=18) and their carers (n= 8) were interviewed 4-6 months post TAVI. Data was themed deductively by applying the theoretical framework of acceptability (1) as an analytic lens, followed by inductive analysis to identify any further emergent themes.

The mean age of patient participants was 85 ± 5 years and 33% were women. Patients experiences of severe AS symptoms (e.g., breathlessness and fatigue) resulted in growing emotions of ‘struggling and pushing to keep to going’ in their daily lives, a few thought they were ‘nearly gone’ and expressed feelings of being scared. Debilitating AS symptoms, and a challenge to the values of this older patient group were the major influencing factors informing high prospective acceptability of the TAVI. Patients and their carers perceived the TAVI procedure to be a ‘good operation’ because of a short hospital stay and minimal disruption to their lives. Low burden resulted in high levels of concurrent acceptability of TAVI. Most patients experienced gradual symptom relief and being able to ‘get back to normal’, be independent and reconnect with valued pastimes, leading to high retrospective acceptability of the intervention for both patients and carers.

Patients and carers perceive TAVI to have high prospective, concurrent, and retrospective acceptability as improved symptoms restored mental wellbeing, the procedure was uncomplicated and operative burden was low, and most patients regained functional capacity and a return to their normal lives. The need to assess acceptability of interventions, such as TAVI, from the perspectives of patients and carers is increasingly becoming important in health care, not only better support patients and carers but to inform effective implementation and sustainability of treatment modalities.