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

Abstract

Objectives: To 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.

Background: TRA has gained significant ground on TFA during the last decades. Surveys on patient preference have mostly been performed in dedicated TRA trials.

Methods: In 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.

Results: 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 < 0.001). Most patients (38.0%) appreciated SDM, balanced between patient and cardiologist.

Conclusions: 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 preference for TRA. Most patients prefer balanced SDM. © 2017 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

Keywords: catheterization; medical decision making; patient preference; transfemoral access; transradial access.

© 2017 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

Figures

Figure 1

A: Relative desirability for procedural characteristics. Characteristics of treatment that are either close to the x or close to the y‐axis were perceived similarly by all patients; in contrast, levels located in the middle were perceived differently. B: Attributes and attribute levels of treatment. Definitions of the individual labels. [Color figure can be viewed at wileyonlinelibrary.com]

Figure 2

Conditional logistic regression of atributes. A high positive coefficient indicates that the attribute was more often chosen as best rather than worst, and thus likely to be preferred relative to other combinations of attributes. [Color figure can be viewed at wileyonlinelibrary.com]

Figure 3

Actual and preferred decision maker. The actual decision maker in the current procedure is depicted by dark bars; the desired decision maker is depicted by light bars. [Color figure can be viewed at wileyonlinelibrary.com]