Clinical Research in Cardiology

Medical graphics to improve patient understanding and anxiety in elderly and cognitively impaired patients scheduled for transcatheter aortic valve implantation (TAVI)
20. Dec. 2023


Autor*innen: A. Brand, C. Hornig, C. Crayen, A. Hamann, S. Martineck, D. M. Leistner, H. Dreger, S. Sündermann, A. Unbehaun, M. Sherif, A. Haghikia, S. Bischoff, J. Lueg, Y. Kühnle, O. Paul, S. Squier, K. Stangl, V. Falk, U. Landmesser & V. Stangl


Background: Anxiety and limited patient comprehension may pose significant barriers when informing elderly patients about complex procedures such as transcatheter aortic valve implantation (TAVI).

Objective: 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).

Clinical Research in Cardiology - Springer Link to paper︎