Professional medical values and ethics have evolved since Hippocrates. Nevertheless, the core values are unscathed: the first concern of physicians is the care of their patients. It is the duty of physicians to listen to their patients, to respect their views and give them information in a way they can understand [
2]. In the current era, where often multiple treatment modalities are available, a physician wants to deliver the best care for his or her individual patient, given co-morbidities, treatment options, outcomes, societal costs and patient preferences. Quality of life as an outcome measure adds an important dimension to clinical outcomes, allowing the introduction of the concept of quality adjusted life years (QALY). But how accurate is physician perception of patient preferences and how can we best assess quality of life? In the domain of cardiovascular surgery and colorectal cancer it was demonstrated that the physician perception of patient preferences can differ considerably from actual patient preferences [
3]. It underlines the importance of gathering evidence of actual patient preferences before and quality of life after cardiac surgery. From a patient perspective it is worth knowing how long it takes to recover from surgery, and if and when one can go back to living their life to the fullest. Surgeons can analyze aortic root diameters, reoperation rates and survival, but measuring a person’s emotional state or physical impairment is more challenging. Tailoring the optimal treatment strategy to the individual patient can be particularly delicate in heart valve and aortic root surgery, as the available treatment options carry different value-sensitive advantages and disadvantages such as bleeding and thrombo-embolic risks, reoperations risks, valve sound and strict anticoagulation management. There is emerging evidence that patients requiring heart valve replacement want to be involved more in their treatment decision making and that involved patients are better informed, less anxious and depressed, and have a better mental well-being [
4]. This is not only important for the patient: from a societal perspective it is crucial that costs of healthcare are contained, while achieving better outcomes. Patient empowerment—including addressing values, preferences and quality of life—is thought to be one of the cornerstones of health care cost containment. Bradley et al. nicely describe the main aspects of ‘value measurements’ in the field of cardiovascular care [
5]. Healthcare value is defined as ‘health outcomes achieved relative to the costs of care’ and they underline the definition proposed by porter that outcomes should reflect the ‘health circumstances most relevant to patients’ [
6].
For all the reasons mentioned above it is crucial that in the cardiovascular domain, with complex patients undergoing complex high-tech procedures, we put emphasis on measuring HRQoL in our outcomes research, and apply this knowledge to further improve our clinical practice.