Abstract
The launch of ‘Rapid Recommendations’ by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) group, in collaboration with Making GRADE the Irresistible Choice (MAGIC) and the British Medical Journal (BMJ), is a very interesting recent development in e-healthcare. Designed to respond quickly to developments that have created new decision situations, their first project resulted from the arrival of minimally invasive Transcatheter Aortic Valve Implantation (TAVI) as an alternative to Surgical Aortic Valve Replacement (SAVR), for patients with symptomatic severe aortic stenosis. The interactive MAGIC decision aid that accompanies a Rapid Recommendation and is the main route to its clinical implementation, represents a major advance in e-health, for a cardiovascular decision in this case. However, it needs to go further in order to facilitate fully person-centred care, where the weighted preferences of the individual person are elicited at the point of decision, and transparently integrated with the best (most personalised) estimates of option performances, to produce personalised, preference-sensitive option evaluations. This can be achieved by inputting the collated GRADE evidence on the criteria relevant in the TAVI/SAVR choice into a Multi-Criteria Decision Analysis-based decision support tool, generating a personalised, preference-sensitive opinion. A demonstration version of this add-on to the MAGIC aid, divested of recommendations, is available online as proof of method.
Highlights
Until a few years ago, a 70-year-old with severe symptomatic aortic stenosis faced a typical life expectancy of 50% at two years, with escalating heart failure and reduced quality of life—unless they were at ‘low or intermediate’ surgical risk, in which case they had the option of open heart surgery for valve replacement (Surgical Aortic Valve Replacement or SAVR)
SAVR decision was the first addressed by the newly-launched collaboration between Grading of Recommendations Assessment, Development and Evaluation (GRADE), Making GRADE the Irresistible Choice (MAGIC), and the British Medical Journal (BMJ) to produce and publish ‘trustworthy recommendations . . . in response to potentially practice changing evidence, so called ‘Rapid Recommendations’ [1] (p. 2)
We suggest SAVR rather than Transcatheter Aortic Valve Implantation (TAVI) [Weak recommendation]
Summary
Until a few years ago, a 70-year-old with severe symptomatic aortic stenosis faced a typical life expectancy of 50% at two years, with escalating heart failure and reduced quality of life—unless they were at ‘low or intermediate’ surgical risk, in which case they had the option of open heart surgery for valve replacement (Surgical Aortic Valve Replacement or SAVR). The arrival of Transcatheter Aortic Valve Implantation (TAVI), with delivery of the replacement valve through the femoral artery, created a new, minimally invasive option. The resulting TAVI or SAVR decision was the first addressed by the newly-launched collaboration between Grading of Recommendations Assessment, Development and Evaluation (GRADE), Making GRADE the Irresistible Choice (MAGIC), and the British Medical Journal (BMJ) (hereafter GRADE+) to produce and publish ‘trustworthy recommendations .
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