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Brand A, Hornig C, Crayen C, Hamann A, Martineck S, Leistner DM, Dreger H, Sündermann S, Unbehaun A, Sherif M, Haghikia A, Bischoff S, Lueg J, Kühnle Y, Paul O, Squier S, Stangl K, Falk V, Landmesser U, Stangl V. Medical graphics to improve patient understanding and anxiety in elderly and cognitively impaired patients scheduled for transcatheter aortic valve implantation (TAVI). Clin Res Cardiol 2023:10.1007/s00392-023-02352-8. [PMID: 38117299 DOI: 10.1007/s00392-023-02352-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Anxiety and limited patient comprehension may pose significant barriers when informing elderly patients about complex procedures such as transcatheter aortic valve implantation (TAVI). OBJECTIVES We aimed to evaluate the utility of medical graphics to improve the patient informed consent (IC) before TAVI. METHODS In this prospective, randomized dual center study, 301 patients were assigned to a patient brochure containing medical graphics (Comic group, n = 153) or sham information (Control group, n = 148) on top of usual IC. Primary outcomes were patient understanding of central IC-related aspects and periprocedural anxiety assessed by the validated Spielberger State Trait Anxiety Inventory (STAI), both analyzed by cognitive status according to the Montreal Cognitive Assessment (MoCA). RESULTS Patient understanding was significantly higher in the Comic group [mean number of correct answers 12.8 (SD 1.2) vs. 11.3 (1.8); mean difference 1.5 (95% CI 1.2-1.8); p < 0.001]. This effect was more pronounced in the presence of cognitive dysfunction (MoCA < 26) [12.6 (1.2) in the Comic vs. 10.9 (1.6) in the Control group; mean difference 1.8 (1.4-2.2), p < 0.001]. Mean STAI score declined by 5.7 (95% CI 5.1-6.3; p < 0.001) in the Comic and 0.8 points (0.2-1.4; p = 0.015) in the Control group. Finally, mean STAI score decreased in the Comic group by 4.7 (3.8-5.6) in cognitively impaired patients and by 6.6 (95% CI 5.8 to 7.5) in patients with normal cognitive function (p < 0.001 each). CONCLUSIONS Our results prove beneficial effects for using medical graphics to inform elderly patients about TAVI by improving patient understanding and reducing periprocedural anxiety (DRKS00021661; 23/Oct/2020). Medical graphics entailed significant beneficial effects on the primary endpoints, patient understanding and periprocedural anxiety, compared to the usual patient informed consent (IC) procedure. Patient understanding of IC-related aspects was significantly higher in the Comic group, with a more pronounced benefit in patients with cognitive impairment (p for IC method and cognitive status < 0.001, respectively; p for IC method x MoCA category interaction = 0.017). There further was a significant decline of periprocedural anxiety in patients with and without cognitive impairment (p for IC method x measuring time point < 0.001; p for IC method x MoCA category x measuring time point interaction = 0.018).
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Affiliation(s)
- A Brand
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany.
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), partner Site Berlin, Berlin, Germany.
| | - C Hornig
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany
| | - C Crayen
- Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195, Berlin, Germany
| | - A Hamann
- Mintwissen-Science Communication Agency and Publishing House, Paulusstr. 11, 40237, Düsseldorf, Germany
| | | | - D M Leistner
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner Site Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Goethe University Hospital, Universitäres Herz- und Gefässzentrum Frankfurt, Frankfurt am Main, 60590, Frankfurt, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Rhein-Main, Munich, Germany
| | - H Dreger
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner Site Berlin, Berlin, Germany
| | - S Sündermann
- DZHK (German Centre for Cardiovascular Research), partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - A Unbehaun
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - M Sherif
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
| | - A Haghikia
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner Site Berlin, Berlin, Germany
| | - S Bischoff
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany
| | - J Lueg
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany
| | - Y Kühnle
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
| | - O Paul
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
| | - S Squier
- Brill Professor Emeritus of English and Women's, Gender and Sexuality Studies, The Pennsylvania State University, University Park, PA, 16802, USA
| | - K Stangl
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany
| | - V Falk
- DZHK (German Centre for Cardiovascular Research), partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - U Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner Site Berlin, Berlin, Germany
| | - V Stangl
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner Site Berlin, Berlin, Germany
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Wamala I, Unbehaun A, Klein C, Kukucka M, Eggert-Doktor D, Buz S, Stein J, Sündermann S, Falk V, Kempfert J. Intraoperative Coregistration of 3D Transesophageal Echocardiography with Live Fluoroscopy Facilitates Transcatheter Mitral Valve-in-Valve Implantation in Cases of Invisible Surgical Valves. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1679002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- I. Wamala
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, German Heart Institute Berlin, Berlin, Germany
| | - A. Unbehaun
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, German Heart Institute Berlin, Berlin, Germany
| | - C. Klein
- Department of Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - M. Kukucka
- Department of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - D. Eggert-Doktor
- Department of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - S. Buz
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, German Heart Institute Berlin, Berlin, Germany
| | - J. Stein
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, German Heart Institute Berlin, Berlin, Germany
| | - S. Sündermann
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, German Heart Institute Berlin, Berlin, Germany
- Department of Cardiothoracic Surgery, Charité Universitätsmedizin, Berlin, Germany
| | - V. Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, German Heart Institute Berlin, Berlin, Germany
- Department of Cardiothoracic Surgery, Charité Universitätsmedizin, Berlin, Germany
| | - J. Kempfert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, German Heart Institute Berlin, Berlin, Germany
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Van Praet K, Sündermann S, Meyer A, Montagner M, Nazari Shafti T, Jacobs S, Falk V, Kempfert J. The Periareolar Approach in Minimally Invasive Surgical Mitral Valve Repair—A Feasible, Safe, and Cosmetically Appealing Technique: A Report on 64 Patients. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- K. Van Praet
- Herz-, Thorax-, und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - S. Sündermann
- Herz-, Thorax-, und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - A. Meyer
- Herz-, Thorax-, und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - M. Montagner
- Herz-, Thorax-, und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - T. Nazari Shafti
- Herz-, Thorax-, und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - S. Jacobs
- Herz-, Thorax-, und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - V. Falk
- Herz-, Thorax-, und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - J. Kempfert
- Herz-, Thorax-, und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany
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Unbehaun A, Meyer A, Hamandi M, Buz S, Klein C, Sündermann S, Falk V, Kempfert J. Transcatheter Aortic Valve Implantation in Bicuspid versus Tricuspid Valve Pathologies - A Propensity Matched Comparison. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A. Unbehaun
- Deutsches Herzzentrum Berlin, Klinik für Herz-, Thorax- und Gefäßchirurgie, Berlin, Germany
| | - A. Meyer
- Deutsches Herzzentrum Berlin, Klinik für Herz-, Thorax- und Gefäßchirurgie, Berlin, Germany
| | - M. Hamandi
- Deutsches Herzzentrum Berlin, Klinik für Herz-, Thorax- und Gefäßchirurgie, Berlin, Germany
| | - S. Buz
- Deutsches Herzzentrum Berlin, Klinik für Herz-, Thorax- und Gefäßchirurgie, Berlin, Germany
| | - C. Klein
- Deutsches Herzzentrum Berlin, Kardiologie, Berlin, Germany
| | - S. Sündermann
- Deutsches Herzzentrum Berlin, Klinik für Herz-, Thorax- und Gefäßchirurgie, Berlin, Germany
| | - V. Falk
- Deutsches Herzzentrum Berlin, Klinik für Herz-, Thorax- und Gefäßchirurgie, Berlin, Germany
| | - J. Kempfert
- Deutsches Herzzentrum Berlin, Klinik für Herz-, Thorax- und Gefäßchirurgie, Berlin, Germany
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Meyer A, Van Praet K, Jacobs S, Sündermann S, Kukucka M, Falk V, Kempfert J. Minimally Invasive Mitral 3D Fully Endoscopic versus Direct Vision Approach: A Propensity Score Matched Comparison. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A. Meyer
- Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - K. Van Praet
- Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - S. Jacobs
- Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - S. Sündermann
- Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - M. Kukucka
- Anästhesiologie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - V. Falk
- Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - J. Kempfert
- Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany
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