Conor Rea’s research while affiliated with Auckland City Hospital and other places

Background: Transcatheter aortic valve implantation (TAVI) is an alternative and effective contemporary intervention to surgical aortic valve replacement (SAVR) for patients with severe aortic valve disease at increased surgical risk. Guidelines recommend a multidisciplinary "Heart Team" (MHT) review of patients considered for a TAVI procedure, but this has been little studied. We reviewed the characteristics, treatments and outcomes of such patients reviewed by the MHT at our centre. Methods: Data on consecutive patients with severe aortic valve stenosis discussed by the Auckland City Hospital MHT from June 2011 to August 2016 were obtained from clinical records. Patient characteristics, treatment and outcomes were analysed using standard statistical methods. Results: Over the 5-year period 243 patients (mean age 80.2 ± 8.0 years, 60% male) were presented at the MHT meeting. TAVI was recommended for 200, SAVR for 26 and medical therapy for 17 patients, with no significant difference in mean age (80.2 ± 8.3, 80.4 ± 6.1, 80.4 ± 7.3 years, respectively) or EuroSCORE II (6.5 ± 4.7%, 5.3 ± 3.6%, 6.7 ± 4.3%, respectively). Over time, there was an increase in the number of patients discussed and treated, with no change in their mean age, but the mean EuroSCORE II significantly decreased (TAVI p = 0.026, SAVR p = 0.004). Survival after TAVI and SAVR was similar to that of the age-matched general population, but superior to medical therapy p = 0.002 (93% (n = 162), 84% (n = 21) and 73% (n = 18) at one year and 85% (n = 149), 84% (n = 21) and 54% (n = 13) at 2 years, respectively). Conclusions: An increasing number of patients were discussed at the MHT meeting with the majority undergoing TAVI, with a similar age and EuroSCORE II to those allocated SAVR or medical therapy. Survival following TAVI and SAVR was superior to medical therapy and similar to the age-matched general population. These findings suggest that the MHT process is robust, consistent and appropriately allocating a limited treatment resource.

Background: Compassion is a core virtue in medicine and lies at the heart of good medical care. It connects us to each other and reflects our need for relationships with others. Aim: Our aim is to explore how palliative care patients perceive, understand and experience compassion from health professionals, and to inform clinical practice. Methods: Seven hospice managers in the North Island of New Zealand were contacted and invited to join the study. Twenty participants expressed a desire to participate and were involved in semi-structured face-to-face interviews. A set of questions guided the interviewers with interviews lasting between 15-60 minutes. Results: In regards to the question, what is your understanding of compassion?, four central themes emerged: connection, presence and warmth, respect and caring. When asked, what advice can you give to trainee health professionals?, participants articulated four themes: connecting with patients and talking in a way they can understand, treating the person with respect, showing interest in them and being a positive presence for them. Conclusions: Compassion was seen as a connection between the carer and the patient. Compassion is having a positive presence and warmth; an attitude of respect and caring. The main advice given by research participants to enhance compassion is for doctors and nurses to connect, to talk in a way that can be understood, and show interest and respect to patients facing the end of their lives.