Evidence map›Paper›PMID 35945706›Full record

ArticleJournal of the American Geriatrics Society2022

Peri-procedural code status for transcatheter aortic valve replacement: Absence of program policies and standard practices.

Gwen M Bernacki, Helene Starks, Ashok Krishnaswami, Jill M Steiner, Matthew B Allen, Wayne B Batchelor, Eugene Yang, Janet Wyman, James N Kirkpatrick

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In one paragraph

Article in Journal of the American Geriatrics Society, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Gwen M BernackiDivision of Cardiology, University of Washington, Seattle, Washington, USA.
Helene StarksCambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA.
Ashok KrishnaswamiKaiser Permanente San Jose Medical Center, San Jose, California, USA.
Jill M SteinerDivision of Cardiology, University of Washington, Seattle, Washington, USA.ORCID 0000-0001-6372-1356
Matthew B AllenDepartment of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Wayne B BatchelorInova Heart and Vascular, Falls Church, Virginia, USA.
Eugene YangDivision of Cardiology, University of Washington, Seattle, Washington, USA.
Janet WymanHenry Ford Health System, Center for Structural Heart Disease, Detroit, Michigan, USA.
James N KirkpatrickDivision of Cardiology, University of Washington, Seattle, Washington, USA.

Funding

Palliative Care Research Training GrantT32HL125195 · NHLBI · UNIVERSITY OF WASHINGTON · PI KROSS, ERIN KATHRYN, SHARMA, RASHMI K. · 2015 to 2024
$3.2M
NHLBI NIH HHS T32 HL125195
6 · The paper itself

Abstract

backgroundLittle is known about policies and practices for patients undergoing Transcatheter Aortic Valve Replacement (TAVR) who have a documented preference for Do Not Resuscitate (DNR) status at time of referral. We investigated how practices across TAVR programs align with goals of care for patients presenting with DNR status.

methodsBetween June and September 2019, we conducted semi-structured interviews with TAVR coordinators from 52/73 invited programs (71%) in Washington and California (TAVR volume > 100/year:34%; 50-99:36%; 1-50:30%); 2 programs reported no TAVR in 2018. TAVR coordinators described peri-procedural code status policies and practices and how they accommodate patients' goals of care. We used data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry, stratified by programs' DNR practice, to examine differences in program size, patient characteristics and risk status, and outcomes.

resultsNearly all TAVR programs (48/50: 96%) addressed peri-procedural code status, yet only 26% had established policies. Temporarily rescinding DNR status until after TAVR was the norm (78%), yet time frames for reinstatement varied (38% <48 h post-TAVR; 44% 48 h-to-discharge; 18% >30 days post-discharge). For patients with fluctuating code status, no routine practices for discharge documentation were well-described. No clinically substantial differences by code status practice were noted in Society of Thoracic Surgeons Predicted Risk of Mortality risk score, peri-procedural or in-hospital cardiac arrest, or hospice disposition. Six programs maintaining DNR status recognized TAVR as a palliative procedure. Among programs categorically reversing patients' DNR status, the rationale for differing lengths of time to reinstatement reflect divergent views on accountability and reporting requirements.

conclusionsMarked heterogeneity exists in management of peri-procedural code status across TAVR programs, including timeframe for reestablishing DNR status post-procedure. These findings call for standardization of DNR decisions at specific care points (before/during/after TAVR) to ensure consistent alignment with patients' health-related goals and values.

Indexed as

Aortic Valve StenosisTranscatheter Aortic Valve ReplacementAftercareAortic ValveHumansPatient DischargePolicyRegistriesRisk AssessmentRisk FactorsTreatment OutcomeUnited Statesdo not resuscitatepalliative careperi-proceduralpolicyTranscatheter aortic valve replacement

Identifiers

PMID35945706
PMCPMC9771878

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.