{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:18:19Z","timestamp":1792783099667,"version":"4.5.0"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T00:00:00Z","timestamp":1703030400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T00:00:00Z","timestamp":1703030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Center for Health Care Research of the German Cardiac Society","id":[{"id":"https:\/\/ror.org\/02p22ad51","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100002839","name":"Charit\u00e9 - Universit\u00e4tsmedizin Berlin","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002839","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Res Cardiol"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anxiety and limited patient comprehension may pose significant barriers when informing elderly patients about complex procedures such as transcatheter aortic valve implantation (TAVI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We aimed to evaluate the utility of medical graphics to improve the patient informed consent (IC) before TAVI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this prospective, randomized dual center study, 301 patients were assigned to a patient brochure containing medical graphics (Comic group,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009153) or sham information (Control group,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009148) on top of usual IC. Primary outcomes were patient understanding of central IC-related aspects and periprocedural anxiety assessed by the validated Spielberger State Trait Anxiety Inventory (STAI), both analyzed by cognitive status according to the Montreal Cognitive Assessment (MoCA).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patient understanding was significantly higher in the Comic group [mean number of correct answers 12.8 (SD 1.2) vs. 11.3 (1.8); mean difference 1.5 (95% CI 1.2\u20131.8);\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001]. This effect was more pronounced in the presence of cognitive dysfunction (MoCA\u2009&lt;\u200926) [12.6 (1.2) in the Comic vs. 10.9 (1.6) in the Control group; mean difference 1.8 (1.4\u20132.2),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001]. Mean STAI score declined by 5.7 (95% CI 5.1\u20136.3;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) in the Comic and 0.8 points (0.2\u20131.4;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015) in the Control group. Finally, mean STAI score decreased in the Comic group by 4.7 (3.8\u20135.6) in cognitively impaired patients and by 6.6 (95% CI 5.8 to 7.5) in patients with normal cognitive function (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 each).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our results prove beneficial effects for using medical graphics to inform elderly patients about TAVI by improving patient understanding and reducing periprocedural anxiety (DRKS00021661; 23\/Oct\/2020).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                    <jats:p>\n                      Medical graphics entailed significant beneficial effects on the primary endpoints, patient understanding and periprocedural anxiety, compared to the usual patient informed consent (IC) procedure. Patient understanding of IC-related aspects was significantly higher in the Comic group, with a more pronounced benefit in patients with cognitive impairment (\n                      <jats:italic>p<\/jats:italic>\n                      for IC method and cognitive status\u2009&lt;\u20090.001, respectively;\n                      <jats:italic>p<\/jats:italic>\n                      for IC method x MoCA category interaction\u2009=\u20090.017). There further was a significant decline of periprocedural anxiety in patients with and without cognitive impairment (\n                      <jats:italic>p<\/jats:italic>\n                      for IC method x measuring time point\u2009&lt;\u20090.001;\n                      <jats:italic>p<\/jats:italic>\n                      for IC method x MoCA category x measuring time point interaction\u2009=\u20090.018)\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00392-023-02352-8","type":"journal-article","created":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T11:02:16Z","timestamp":1703070136000},"page":"302-312","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Medical graphics to improve patient understanding and anxiety in elderly and cognitively impaired patients scheduled for transcatheter aortic valve implantation (TAVI)"],"prefix":"10.1007","volume":"114","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0383-0347","authenticated-orcid":false,"given":"A.","family":"Brand","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Hornig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Crayen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Hamann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Martineck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. 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VF declares relevant financial activities outside the submitted work: Medtronic GmbH, Biotronik SE & Co., Abbott GmbH & Co. KG, Boston Scientific, Edwards Lifesciences, LivaNova, Berlin Heart, Novartis Pharma GmbH, JOTEC GmbH, Zurich Heart in relation to Educational Grants (including travel support), Fees for lectures and speeches, Fees for professional consultation, Research and study funds. AB, CH, CC, AH, SM, DML, SS, AU, MS, AH, SB, JL, YK, OP, SS, KS, UL, VS declare no conflicts of interest in relation with the submitted work.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All patients gave verbal and written informed consent for study participation. The study was reviewed and approved by the institutional ethics committee of the Charit\u00e9\u2014University Medicine Berlin (registration number EA1\/139\/20) and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent"}}]}}