June 18, 2017
PREVAS Determines Vascular Access Preference of Patients Undergoing Elective Coronary Procedures
June 19, 2017—Online in Catheterization and Cardiovascular Interventions, Marlies M. Kok, MD, et al published findings from the PREVAS study of patient preference for radial versus femoral vascular access for elective coronary procedures.
The investigators assessed patient preference for vascular access site in percutaneous coronary procedures and the perceived importance of benefits and risks of transradial access (TRA) and transfemoral access. In addition, direct preference for vascular access and preference for shared decision making (SDM) were evaluated.
In the PREVAS study, a stated preference elicitation method of best-worst scaling was used to determine patient preference for six treatment attributes: bleeding, the switch of access-site, postprocedural vessel quality, mobilization, comfort, and overnight stay. Based on software-generated treatment scenarios, 142 patients indicated which characteristics they perceived most and least important in treatment choice. The investigators calculated best-minus-worst scores and attribute importance.
As summarized in Catheterization and Cardiovascular Interventions, bleeding risk was considered most important (attribute importance, 31.3%), followed by length of hospitalization (22.6%), and mobilization (20.2%). Most patients preferred the approach of their current procedure (85.9%); however, 71.1% of patients with experience with both access routes favored TRA (P < .001). Most patients (38%) appreciated SDM, balanced between patient and cardiologist.
The findings indicate that patients appreciate lower bleeding risk and early ambulation, factors favoring TRA. Previous experience with a single access route has a major impact on preference, while experience with both routes generally resulted in a preference for TRA. Most patients prefer balanced SDM, concluded the investigators in Catheterization and Cardiovascular Interventions.