TAVR Benefit, Risk Information Deficient on Most Hospital Websites: Analysis

Marlene Busko

January 14, 2015

PHILADELPHIA, PA — Among US hospitals performing transcatheter aortic-valve replacement (TAVR) procedures, virtually all hospitals with web pages about this procedure tout its benefits, but only a quarter mention specific risks, new research shows[1].

The study, published as a research letter online January 12, 2015 in JAMA Internal Medicine, looked for the mention of 11 potential risks and 11 potential benefits of TAVR compared with surgical aortic-valve replacement, which were identified in PARTNER.

The web pages "may understate the established risks of [TAVR] and provide little context for the magnitude of those risks to inform patient decision making," Mariah L Kincaid (Tufts University School of Medicine, Boston, MA) and colleagues write. They call for hospitals to improve the risk/benefit information on their websites to promote the appropriate use of TAVR.

TAVR is a "very exciting procedure that . . . has the potential to offer a lot of people real benefits that didn't exist before . . . but we're concerned that these kinds of [unbalanced] web pages have the potential to influence [patient decisions]," senior author Dr Mark D Neuman (University Pennsylvania, PA) told heartwire .

When discussing TAVR with patients, clinicians need to probe to find out about potential imbalanced information patients may have gleaned from hospital websites, the researchers say.

Most Adults Seek Medical Information on the Web

Researchers estimate that 78% of US adults look for medical information on the internet, Kincaid and colleagues write. Although recent clinical trials have shown that patients who undergo TAVR have twice the risk of stroke compared with patients who have surgical aortic-valve replacement, ads promoting TAVR did not appear to discuss this risk, Neuman said.

From the Society of Thoracic Surgeons and the American College of Cardiology Transcatheter Valve Therapy Registry, Kincaid et al identified 317 US hospitals that offered TAVR. Of those, 262 hospitals produced their own web pages describing the procedure.

Most hospitals were nongovernmental, nonprofit institutions (81.3%) and were affiliated with medical schools (81.7%); almost all were in urban areas (97%), and most had more than 400 beds (69.8%).

During May and June of 2014 they viewed the hospitals' web pages about TAVR to see if they mentioned the 22 specific risks and benefits.

Whereas 99.2% of the websites described at least one benefit of TAVR relative to surgical aortic-valve replacement, 23% mentioned at least one risk (P<0.001). Only 37% of the websites specified the size of the benefit, and even fewer (4.6%) specified the magnitude of the risks.

The most commonly mentioned benefits of TAVR vs surgical aortic-valve replacement were lower degree of invasiveness (mentioned on 95.4% of websites), potential for more rapid recovery (47.7% of websites), lack of requirement for cardiopulmonary bypass (45.8% of websites), and improved quality of life (45.4% of websites).

The most commonly mentioned risks of TAVR were stroke or transient ischemic attack (18.3% of websites), vascular complications (13.7% of websites), death (11.8% of websites]), and unknown long-term valve durability (10.7% of websites).

Clinicians Need to Probe for TAVR Misconceptions

These data build on prior studies that found incomplete, imbalanced information in print and television advertisements for clinical services, Dr Yael Schenker (University of Pittsburgh, PA) and Dr Alex John London (Carnegie Mellon University, Pittsburgh, PA) write in an accompanying editorial[2].

Now, "as patients seek information online, they are venturing into a highly competitive environment in which hospitals, driven by market pressures and a focus on patient choice via health-insurance exchanges, increasingly use the internet to reach wider audiences and attract potential patients," they note.

According to the editorialists, Kincaid and colleagues raise four significant concerns.

First, patients may not be aware that they are consuming promotional materials rather than impartial educational resources.

Second, it is difficult to find unbiased information, since hospital advertising is overseen by the Federal Trade Commission and hospitals are not required by law to disclose procedure risks, unlike direct-to-consumer ads for prescription drugs, overseen by the Food and Drug Administration and which must present a "fair balance of risks and benefits."

Third, patients may not recognize that medical information is incomplete, imbalanced, and of poor quality. For example, if a car advertisement fails to mention gas mileage, consumers will generally look for this information elsewhere. However, if web pages about TAVR fail to mention the risk of kidney disease or vascular complications, patients are unlikely to ask about this when discussing the procedure with their physician.

Fourth, patient preferences are increasingly being solicited as medicine shifts away from paternalistic care; strong patient preferences may be based on poor-quality information from online advertising.

Thus, like the researchers, Schenker and London stress that "clinicians should ask patients what they have learned from online medical searches and assist them in forming a complete picture of the risks and benefits of treatment options." Moreover, "the risk that imbalanced information on US hospital websites may negatively impact patient decision making should be an area of close scrutiny and may provide support for stricter advertising regulations."

The study was supported by grants from the National Institute on Aging and the Foundation for Anesthesia Education and Research. The authors and editorialists report they have no relevant financial relationships.

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