Patient preference for radial versus femoral vascular access for elective coronary procedures: The PREVAS study

Abstract

ObjectivesTo explore patient preference for vascular access site in percutaneous coronary procedures, the perceived importance of benefits and risks of transradial access (TRA) and transfemoral access (TFA) were assessed. In addition, direct preference for vascular access and preference for shared decision making (SDM) were evaluated.BackgroundTRA has gained significant ground on TFA during the last decades. Surveys on patient preference have mostly been performed in dedicated TRA trials.MethodsIn the PREVAS study (Clinicaltrials.gov: NCT02625493) a stated preference elicitation method best‐worst scaling (BWS) was used to determine patient preference for six treatment attributes: bleeding, switch of access‐site, postprocedural vessel quality, mobilization and comfort, and over‐night stay. Based on software‐generated treatment scenarios, 142 patients indicated which characteristics they perceived most and least important in treatment choice. Best‐minus‐Worst scores and attribute importance were calculated.ResultsBleeding 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 < 0.001). Most patients (38.0%) appreciated SDM, balanced between patient and cardiologist.ConclusionsPatients 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 preference for TRA. Most patients prefer balanced SDM. © 2017 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

Relative importance of attribute preferences for radial vs. femoral arterial access: A crowdsourcing study of healthy online‐recruited volunteers

“…Our participants were also healthier than the typical patient requiring a coronary artery procedure. Yet, with respect to patient preference for specific attributes, our results mirrored those of Kok et al, which surveyed real patients with a coronary procedure history. These similarities between healthy individuals and real patients strongly support MTURK as a valid sampling tool for future research.…”

Radial artery access site complications during cardiac procedures, clinical implications and potential solutions: The role of nitric oxide

“…Vascular access can be achieved via the femoral artery or, more recently, the RA [9][10][11] . Although femoral artery access is still used, it has several disadvantages compared to the RA approach, including longer bed rest, difficult access through the tortuous aorta, the need for puncture site compression after the procedure, and vascular complications of arteriovenous fistula and haematoma [9] .…”

Using Best-Worst Scaling to Understand the Preferences of Stroke Survivors, their Relatives/Carers and the Public on Providing Stroke Thrombectomy Services in England

“…BWS has been used in a variety of health and health care settings. For instance, recently published studies have used BWS to understand patient, carer and public preferences on multiple aspects of healthcare, particularly on medical treatments [27][28][29][30]. In this study, we used the BWS pro le/attribute case method (also referred to in the literature as 'Case 2'), in which the importance of each contributing attribute of a decision is evaluated relative to all other attributes.…”