Evaluation of a medical education comic in anxious patients before transcatheter aortic valve implantation: patient satisfaction and effects on individual disease experience

Laura Baez (Jena)1, F. Thiele (Jena)1, C. Lasch (Jena)1, S. Möbius-Winkler (Jena)1, M. Diab (Rotenburg an der Fulda)2, T. Kräplin (Jena)3, C. Schulze (Jena)1, G. Dannberg (Jena)1, M. Franz (Jena)1

1Universitätsklinikum Jena Klinik für Innere Medizin I - Kardiologie Jena, Deutschland; 2Herz-Kreislauf-Zentrum, Klinikum Hersfeld-Rotenburg GmbH Rotenburg an der Fulda, Deutschland; 3Universitätsklinikum Jena Klinik für Herz- und Thoraxchirurgie Jena, Deutschland


Background and aims:

Mental comorbidities, in particular depression and anxiety, are frequent in elderly patients with symptomatic aortic stenosis (AS). After aortic valve replacement, improvements of such mental disorders, probably due to reduced clinical symptoms, could be recently shown by our group. The question arises, whether further supportive interventions are beneficial for those patients. In that context, medical graphic narratives as an additional component of the informed consent (IC) procedure have been introduced.

This study was aimed to develop a medical graphic narrative of the transcatheter aortic valve implantation (TAVI) procedure and evaluate patient satisfaction and effects on individual disease experience in typical elderly AS patients.  


For this preliminary analysis, a total of 50 anxious patients with severe AS undergoing transfemoral TAVI at the University Hospital Jena were available. Anxiety was defined by ≥ 8 points in the Hospital Anxiety and Depression Scale (HADS-D). All patients gave informed consent to participate in the prospective randomized COMTAVI study, which is still running. Here, patients undergo randomization into a standard IC (control) and a standard IC plus comic (comic) group. The comic has been newly developed and tells the journey of a TAVI patient from admission to discharge. Disease experience was measured using a seven-item questionnaire with a range from 1 (less) to 6 (more) for each item and performed before and after IC procedure (both before TAVI). Patient satisfaction with the IC procedure was measured using a five-item questionnaire with a range from 1 (less) to 6 (more) for each item (after TAVI before discharge).


Results: The mean age of patients in this anxious TAVI cohort (n=50) was 83 ± 5 years, 60% were female and the mean STS score was 4.6 ± 4.5%. All patients were successfully treated by transfemoral TAVI. 26 patients were randomized into the comic and 24 into the control group. The majority of clinical baseline characteristics did not show significant differences between the groups. Comparison of disease experience between the study groups, revealed a significant difference for one item (knowledge of postinterventional behavioral instructions) at the time point after IC (p=0.03). Analysis of the disease experience dynamics within the study groups before and after IC, showed improvements for two items (knowledge of planned intervention knowledge of postinterventional behavioral instructions) in both groups and for one item (own contribution to recovery) in the comic group (p<0.05 for all). With respect to the satisfaction with the IC procedure, two out of five items were significantly better in the comic compared to the control group (level of self-control and adherence to postinterventional behavioral instructions, both p<0.05).


Conclusions: In this first preliminary analysis of the currently ongoing COMTAVI study, we could should show for the first time that a medical graphic narrative is a feasible tool to support the IC procedure in TAVI patients. Patient satisfaction can be relevantly improved and there might be further benefits with respect to individual disease experience and self-determined coping of illnes.

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